Objectives: Syncope is a common cause of the transient loss of consciousness, with neurally mediated syncope (NMS) and particularly vasovagal syncope (VVS) being the most prevalent types among older children and adolescents. VVS is primarily caused by heightened parasympathetic activity triggered by emotional or postural stimuli, resulting in a temporary disruption of circulation. Although anamnesis and physical examination play key roles in diagnosing VVS, additional diagnostic methods are necessary in unclear cases. This study aims to evaluate the long-term outcomes of pediatric patients with syncope, focusing on clinical characteristics, diagnosis, and treatment approaches. Methods: A retrospective analysis was conducted on 455 pediatric patients aged 8–21 years who presented with syncope at our cardiology clinic between 2005 and 2023. Patients diagnosed with cardiac syncope, epilepsy, or postural orthostatic tachycardia syndrome (POTS) were excluded. The remaining 283 patients were categorized into two groups: those with confirmed VVS—based on a comprehensive evaluation, including medical history, physical examination, and electrocardiography—and those suspected of VVS who lack a confident diagnosis after an initial assessment requiring tilt table testing. Clinical features, diagnostic methods, and treatment outcomes were analyzed. Results: The study cohort had a mean age of 13.5 ± 1.6 years, with a female predominance of 69%. Among patients who underwent tilt table testing (TTT), 74.8% exhibited a positive response, with mixed-type syncope being the most prevalent (51%). Syncope recurrence was significantly higher in the TTT group (54%) compared to the clinically diagnosed group (15%) (p < 0.001). Relapse risk was strongly associated with the syncope subtype, particularly cardioinhibitory type 2B (OR: 2.3, 95% CI: 1.1–4, p < 0.01), and episode frequency (OR: 1.7, 95% CI: 1.3–2.5, p = 0.03). Beta-blocker therapy was selectively administered and demonstrated a reduced relapse risk in a univariate analysis. Conclusions: VVS is a significant health issue in pediatric patients and the therapeutic modalities available encompass various interventions, including modifications to lifestyle, adequate hydration, and pharmacological therapies. TTT was found to be an effective diagnostic tool for identifying high-risk patients and is recommended for appropriate cases in pediatric VVS diagnosis in accordance with the guidelines, with the objective of refining therapeutic methodologies and ultimately augmenting patient prognoses.

Background/Objectives: Secundum-type atrial septal defect (ASD) is one of the most common congenital heart defects, with an incidence of 5.64 per 10,000 live births worldwide. In our study, long-term follow-up results of children who underwent percutaneous ASD closure and patients who underwent surgical treatment were evaluated using right ventricular strain echocardiography and electrocardiography. Methods: 30 patients who underwent transcatheter ASD closure and 30 patients provided with surgical ASD closure were prospectively compared with 50 healthy children with similar demographic characteristics. ECG and transthoracic echocardiography were performed for all patients. The evaluated echocardiography variables are Tricuspid annular plane systolic excursion (TAPSE), 2D right ventricle (RV) and right atrium (RA) dimensions, right ventricular segmental longitudinal strain, and global longitudinal strain. ECG evaluation was performed especially in terms of QRS duration and its correlation with strain echo measurements. Results: The surgical treatment group has statistically significant ASD size compared to patients who underwent transcatheter closure (20 ± 3.6 and 14.87 ± 3.7 mm, p < 0.001). Patients who had surgical treatment have increased RA and RV diameters, and a statistically significant decrease was observed in right ventricular free-wall longitudinal strain and right ventricular four-chamber longitudinal strain compared to patients in transcatheter and the control group (p < 0.001). QRS durations were similarly normal in electrocardiography in the transcatheter and the control groups, and the QRS duration was observed as statistically significantly increased in the patients in the surgical treatment group (p < 0.001). Conclusions: Strain values of the patients who underwent surgical closure were lower, and the QRS values on the ECG were longer, compared to the transcatheter group, which is an indicator that a large ASD diameter has a negative effect on long-term right ventricular function. With this in mind, we argue that early surgical closure is an appropriate treatment option for children whose ASD is large for their age and who are not suitable candidates for transcatheter treatment.

Background/Objectives: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in pediatric epilepsy. Cardiac arrhythmias, possibly reflected by electrocardiographic (ECG) abnormalities, are thought to contribute significantly to SUDEP risk. This study aimed to evaluate ECG indices associated with an increased risk of both atrial and ventricular arrhythmias and sudden cardiac death in pediatric patients with generalized and focal seizures, excluding those with underlying channelopathies. Materials and Methods: Pediatric patients aged 0–18 years with generalized or focal epilepsy followed at our center between October 2024 and April 2025 were enrolled. Comprehensive cardiac evaluations, including echocardiography and 12-lead ECG, were conducted. Patients with channelopathies, structural heart defects, or significant congenital heart disease were excluded. ECG parameters—QT dispersion (QT Disp), corrected QT interval (QTc), QTc dispersion (QTc Disp), P-wave dispersion (P Disp), and T peak-T end interval (Tp-e)—were analyzed across epilepsy subgroups and compared to healthy controls. Effects of antiepileptic drug (AED) use and gender were also assessed. Results: A total of 151 participants were included (generalized: n = 51; focal: n = 50; controls: n = 50). QTc and Tp-e intervals were prolonged in both epilepsy groups compared to controls (p = 0.001 and p = 0.036, respectively), however, they fell within the conventional parameters. AED use was associated with further prolongation of QTc (p = 0.035) and Tp-e (p = 0.037), these metrics were similarly found to be within the established normative boundaries. Phenobarbital and lamotrigine users showed the longest QTc, albeit not statistically significant. Males with generalized seizures had longer maximum P-wave duration (P Max) than females (p = 0.009). A moderate correlation was found between Tp-e and QTc (r = 0.557, p = 0.001). Conclusions: Although there are findings in our study that may suggest a relationship between SUDEP and arrhythmia according to electrocardiographic markers associated with arrhythmia risk, larger and prospective studies with long-term follow-up are needed in the future.

Background/Objectives: It has been shown that the use of statins in patients with type 2 diabetes mellitus (T2DM) worsens hyperglycemia and hemoglobin A1c levels but may help in the preservation of pancreatic β-cell function. The potential role of a high pancreatic fat fraction (PFF) in this process has not yet been clarified. This study aimed to investigate whether the liver fat fraction (LFF) and PFF in T2DM patients is affected by statin therapy. Methods: This cross-sectional study involved a total of 140 T2DM patients, including both those who were receiving (n = 70) and those who were not receiving (n = 70) statin therapy. The mapping of the LFF and PFF utilizing the IDEAL-IQ sequence was conducted in magnetic resonance imaging. Results: In T2DM patients who used statins, the median PFF was higher compared to those who did not use statins (8.4 vs. 6.2%, p = 0.021), while the median LFF was found to be similar (8.4 vs. 8.9, p = 0.572). Variations in PFF were associated with the use of various statins (non-statin group: 6.2 vs. atovastatin: 8.7 vs. rosuvastatin: 3.2 vs. pitavastatin: 9.2, p = 0.004). The multivariable regression analysis indicated that insulin usage decreased log(LFF) by a factor of 0.16-fold (ꞵ ± SE = −0.16 ± 0.05, p = 0.010), and rosuvastatin usage reduced log(PFF) by 0.16-fold (ꞵ ± SE = −0.16 ± 0.07, p = 0.025), irrespective of other risk factors. Furthermore, the use of atorvastatin (ꞵ ± SE = 0.17 ± 0.06, p = 0.011) and pitavastatin (ꞵ ± SE = 0.19 ± 0.07, p = 0.008) were independently associated with an increase in log(PFF). Conclusions: In patients with T2DM, statin use did not show a significant effect on the liver fat fraction, but it caused differences in the pancreatic fat fraction. The observation of a lower pancreatic fat fraction in patients taking a rosuvastatin and atorvastatin dose of 40 mg/day suggests that different types and doses of statins may have varying effects on pancreatic fat accumulation.

The most common cause of death in patients with Duchenne muscular dystrophy (DMD) is cardiomyopathy. Our aim was to investigate the relationship between the Tpeak–Tend (Tp-e) interval and the premature ventricular contraction (PVC) burden and therefore early arrhythmic risk and cardiac involvement in DMD patients. Twenty-five patients with DMD followed by pediatric cardiology were included in the study. Those with a frequency of 1% were assigned to Group 2 (n = 10). Comparisons were made with healthy controls (n = 27). Left ventricular ejection fraction (LVEF) was lowest in Group 2 and highest in the control group (p < 0.001). LV end-diastolic diameter was greater in Group 2 than in Group 1 and the control group (p = 0.005). Pro-BNP and troponin levels were higher in Group 1 and Group 2 than in the control group (p = 0.001 and p < 0.001, respectively). Tp-e interval was longer in Group 2 compared to Group 1 and the control group (p < 0.001). The LVEF (OR 0.879, 95% CI 0.812–0.953; p = 0.002) and Tp-e interval (OR 1.181, 95% CI 1.047–1.332; p = 0.007) were independent predictors of PVC/24 h frequency of >1%. A Tp-e interval > 71.65 ms predicts PVC > 1%, with a sensitivity of 80% and a specificity of 90% (AUC = 0.842, 95% CI (0.663–1.000), p = 0.001). Determination of Tp-e prolongation from ECG data may help in the determination of cardiac involvement and early diagnosis of arrhythmic risk in DMD.

Objective: Although obesity is a well-established risk factor for coronary artery disease (CAD), several recent studies have paradoxically demonstrated lower cardiovascular mortality rates among obese individuals. This study aimed to compare the extent of CAD between obese and non-obese diabetic patients and evaluate the presence of the obesity paradox in this population.Materials and Methods: A total of 1,557 patients who underwent coronary angiography were retrospectively screened. Fifty-three diabetic patients were included and divided into two groups according to body mass index (BMI): ≥30 and <30. The groups were matched for age, gender, and other cardiovascular risk factors. The extent of CAD was assessed using the SYNTAX score. Statistical analyses were performed using IBM SPSS Statistics version 27, and a p-value of <0.05 was considered statistically significant.Results: There were no statistically significant differences between the groups (BMI ≥30 vs. <30) regarding age, gender, HbA1c, LDL, total cholesterol, creatinine levels, hypertension, family history, atrial fibrillation, cerebrovascular disease, and smoking status. The SYNTAX score was significantly lower in the obese group (12.67±9.68) compared to the non-obese group (19±12.68) (p=0.046).Conclusion: Among diabetic patients, those who were obese had significantly less extensive and severe CAD compared to their non-obese counterparts, supporting the concept of the obesity paradox.