Introduction: Iron deficiency is a prevalent comorbidity in patients with heart failure (HF) and is associated with adverse outcomes. Traditional markers such as ferritin and transferrin saturation may be misleading due to the confounding impact of systemic inflammation. This study aimed to develop and validate the Adjusted Ferritin Inflammation Index (AFII), a novel composite score integrating ferritin/C-reactive protein (CRP) ratio and albumin levels, to improve mortality risk stratification in HF patients. Methods: This retrospective cohort study included 322 patients with HF and reduced or mildly reduced ejection fraction (HF with reduced ejection fraction: left ventricular ejection fraction ≤40%; HF with mildly reduced ejection fraction: left ventricular ejection fraction 41%–49%). Patients were evaluated for iron parameters between January 2017 and September 2023. Laboratory values (ferritin, CRP, and albumin) were obtained at admission for inpatients or at the first outpatient evaluation. Baseline characteristics were compared between survivors and deceased patients. Adjusted Ferritin Inflammation Index was derived using logistic regression and calculated as: AFII = (Albumin × −0.168) + (Ferritin/CRP × −0.012) + 6.958. The score was log-transformed (Base 2), and the optimal cut-off (2.1) was determined via receiver-operating characteristic curve analysis. Mortality predictors were assessed using Cox regression, and survival differences were analysed with Kaplan–Meier curves. Results: During a median follow-up of 41 months, 106 patients (32.9%) died. In multivariate Cox regression, AFII ≥ 2.1 independently predicted mortality (hazard ratio: 2.155; 95% confidence interval: 1.361–3.412; P = .001), along with New York Heart Association (NYHA) class, sodium, brain natriuretic peptide, and smoking. Ferritin and transferrin saturation were not associated with survival (P = .733 and P = .790, respectively). The AFII showed superior predictive performance [area under the curve (AUC): 0.713] compared with ferritin/CRP (AUC: 0.438) and albumin (AUC: 0.694). Kaplan–Meier analysis showed significantly reduced survival in patients with AFII ≥ 2.1 across the overall cohort (3-year survival: 54.9% vs 84.6%). Conclusion: Adjusted Ferritin Inflammation Index is a novel inflammation-adjusted metric that independently predicts mortality in HF with reduced ejection fraction/HF with mildly reduced ejection fraction patients and outperforms traditional iron markers. Its use may enhance risk stratification and inform future strategies for iron deficiency management in HF.

In healthcare, emergent clinical decision-making is complex and large language models (LLMs) may enhance both the quality and efficiency of care by aiding physicians. Case scenario-based multiple choice questions (CS-MCQs) are valuable for testing analytical skills and knowledge integration. Moreover, readability is as important as content accuracy. This study aims to compare the diagnostic and treatment capabilities of GPT-4.o and Gemini-1.5-Flash and to evaluate the readability of the responses for cardiac emergencies. A total of 70 single-answer MCQs were randomly selected from the Medscape Case Challenges and ECG Challenges series. The questions were about cardiac emergencies and were further categorized into four subgroups according to whether the question included a case presentation or an image, or not. ChatGPT and Gemini platforms were used to assess the selected questions. The Flesch–Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) scores were utilized to evaluate the readability of the responses. GPT-4.o had a correct response rate of 65.7%, outperforming Gemini-1.5-Flash, which had a 58.6% correct response rate (p=0.010). When comparing by question type, GPT-4.o was inferior to Gemini-1.5-Flash only for non-case questions (52.5% vs. 62.5%, p=0.011). For all other question types, there were no significant performance differences between the two models (p>0.05). Both models performed better on easy questions compared to difficult ones, and on questions without images compared to those with images. Additionally, while GPT-4.o performed better on case questions than non-case questions. Gemini-1.5-Flash’s FRE score was higher than GPT-4.o’s (median [min-max], 23.75 [0-64.60] vs. 17.0 [0-56.60], p

Heart failure is an important health problem with an increasing prevalence all over the world due to the aging population and comorbidities. Unfortunately, there may be delays in detecting symptoms and initiating appropriate treatment. Therefore, it is of great importance that physicians in all departments have sufficient kwowledge and awareness of heart failure. This is the first study in our country to evaluate the kwowledge and awareness levels on heart failure among medical students. The socio-demographic characteristics of the participants and kwowledge and awareness on the definition of heart failure, its causes, signs and symptoms, complications, treatment and about lifestyle recommendations were evaluated using a questionnaire. The survey questions were created by the research team in the light of the studies in the literature. A total of 269 students, 134 female (49.8%) and 135 male (50.2%) participated in the study. 58.7% of the students consist of 1st year and 41.3% of them were 6th grade medical faculty students. When the percentages of correctly answered questions were evaluated, 6th grade students gave more correct answers than 1st grade students (median [min-max] 80.9% [48.9-97.9] vs median [min-max] 68.1%) [2.1-93.6],p<0.001). Students have less knowledge about advanced heart failure treatments such as heart transplantation and artificial heart compared to other treatment methods. Although knowledge and awareness of heart failure increases after they receive theoretical course and clinical internship training, advanced heart failure treatment methods such as heart transplantation and artificial heart should be more involved in education programs. Kalp yetersizliği, yaşlanan nüfus ve komorbiteler nedeniyle tüm dünyada prevalansı artış gösteren önemli bir sağlık sorunudur. Ne yazık ki belirtileri geç fark edilip uygun tedavinin başlanmasında gecikmeler olabilmektedir. Bu nedenle tüm branşlardaki hekimlerin kalp yetersizliği bilgi ve farkındalık düzeyinin yeterli olması büyük önem taşımaktadır. Bu araştırma ülkemizde tıp fakültesi öğrencilerinde kalp yetersizliği bilgi ve farkındalık düzeylerini değerlendirmek amacıyla yapılan ilk araştırmadır. Katılımcıların sosyo-demografik özelikleri ve kalp yetersizliğinin tanımı, nedenleri, belirti ve bulguları, komplikasyonları, tedavisi, kalp yetersizliğinde yaşam tarzı önerileri hakkındaki anket soruları ile kalp yetersizliği bilgi ve farkındalık düzeyleri değerlendirilmiştir. Anket soruları literatürde yer alan çalışmalar ışığında araştırma ekibi tarafından oluşturulmuştur. Çalışmaya 134 kadın (%49,8) ve 135 erkek (%50,2) toplam 269 öğrenci katılmıştır. Öğrencilerin %58,7’si 1. sınıf ve %41,3’ü 6. sınıf tıp fakültesi öğrencilerinden oluşmaktadır. Doğru cevaplanan soru yüzdeleri değerlendirldiğinde 6. sınıf öğrencileri 1. sınıf öğrencilerine göre daha fazla doğru yanıt vermiştir ( median [min-maks] %80,9 [48,9-97,9] vs median [min-maks] %68,1 [2,1-93,6],p<0,001). Öğrencilerin diğer tedavi yöntemlerine göre kalp nakli, yapay kalp gibi ileri evre kalp yetersizliği tedavileri hakkında bilgisi daha azdır. Teorik ders ve klinik staj eğitimi aldıkça kalp yetersizliği bilgi ve farkındalığı artmakla beraber kalp nakli, yapay kalp gibi ileri evre kalp yetersizliği tedavi yöntemlerine eğitim programlarında daha fazla yer verilmelidir.

Background/Objectives: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous multisystem syndrome in which conventional cardiac measures may not fully capture systemic vulnerability. The Endothelial Activation and Stress Index (EASIX) is prognostic in other cardiovascular populations, but evidence in HFpEF remains limited. We evaluated the association of EASIX with long-term mortality and compared its prognostic value with the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score. Methods: This retrospective single-center study included 79 adults hospitalized with HFpEF between 2019 and 2025. EASIX, PNI, and CONUT were calculated from admission laboratory values. The endpoint was all-cause mortality. EASIX was modeled using restricted cubic splines. Incremental value beyond age, serum sodium, and B-type natriuretic peptide was assessed using likelihood-ratio tests. Harrell’s C-index was internally validated using 1000 bootstrap resamples; conventional and time-dependent receiver operating characteristic analyses were also performed. Results: During a median follow-up of 27.6 months, 45 patients (57.0%) died. EASIX was nonlinearly associated with mortality (overall and nonlinearity p < 0.001) and improved clinical model fit (Δχ² = 24.36; p < 0.001). PNI improved the clinical model without EASIX (Δχ² = 8.74; p = 0.003), but its contribution after EASIX was attenuated (Δχ² = 3.54; p = 0.060); CONUT did not improve model fit (p = 0.859). Optimism-corrected C-indices were 0.728 for clinical + EASIX and 0.732 after adding PNI. Conventional AUCs were 0.753, 0.782, and 0.661 for EASIX, PNI, and CONUT, respectively. Conclusions: In this selected hospitalized HFpEF cohort, EASIX provided incremental prognostic information beyond clinical markers. These exploratory findings require confirmation in larger prospective cohorts with external validation.

Endothelial dysfunction, inflammation, and microvascular injury are key mechanisms involved in the development and progression of acute coronary syndrome (ACS). The Endothelial Activation and Stress Index (EASIX) and its derivatives have emerged as readily available biomarkers of endothelial stress; however, the prognostic value of modified EASIX (m-EASIX), which incorporates C-reactive protein, remains uncertain. This study evaluated the prognostic performance of EASIX-derived indices and investigated whether high admission m-EASIX was independently associated with long-term post-discharge all-cause mortality in patients with ACS. Adult patients admitted with ACS between January 2019 and February 2020 who survived the index hospitalization and were discharged alive were retrospectively identified from a tertiary referral center. EASIX, simplified EASIX (s-EASIX), and m-EASIX were calculated from admission laboratory measurements, and their prognostic performance was evaluated using receiver operating characteristic analysis, Kaplan–Meier survival curves, and multivariable Cox proportional hazards models. Among 102 patients who survived the index ACS hospitalization, 29 (28.4%) died during a mean post-discharge follow-up of 68.2 ± 28.0 months. m-EASIX showed the numerically highest AUC for post-discharge all-cause mortality (AUC 0.730, 95% CI 0.617–0.843; p<0.001), followed by EASIX (AUC 0.715) and s-EASIX (AUC 0.629). However, paired DeLong comparisons showed no significant difference between m-EASIX and EASIX (p=0.809) or between m-EASIX and s-EASIX (p=0.158). Patients with m-EASIX ≥1.21 had significantly higher mortality than those with lower values (53.7% vs. 11.5%; p<0.001). After adjustment for age, hemoglobin concentration, and left ventricular ejection fraction, high m-EASIX remained independently associated with post-discharge all-cause mortality (HR 2.759, 95% CI 1.109–6.865; p=0.029). Among the evaluated indices, m-EASIX showed the numerically highest AUC, although its discriminatory performance was not statistically superior to that of EASIX or s-EASIX. Further prospective validation is required before clinical implementation.

Background/Objectives: Hematopoietic stem cell transplantation (HSCT) exposes patients to cardiovascular stress through inflammation, metabolic disturbances, and prior cardiotoxic therapies. Although overt dysfunction is uncommon early after transplantation, subclinical cardiac adaptation remains poorly defined. Methods: We evaluated early electrical and mechanical cardiac responses after HSCT using integrated electrocardiographic (ECG) and echocardiographic assessment. In this prospective cohort study, patients underwent paired pre-transplant and early post-transplant (3–6 months) ECG and comprehensive echocardiography, including tissue Doppler and speckle-tracking analyses of atrial, ventricular, and right heart function. Results: Patients were stratified into multiple myeloma (MM) and non-MM subgroups. ECG voltage increased after HSCT, particularly in MM patients, without changes in left ventricular (LV) mass, geometry, or global systolic indices, suggesting electrical–structural dissociation. Left atrial (LA) reservoir strain decreased despite stable atrial volumes. Diastolic indices showed selective modulation, including a group-time interaction in the lateral e′/a′ ratio without elevated filling pressures. Subgroup analyses suggested divergent myocardial responses, with numerical global longitudinal strain (GLS) improvement in MM patients and reduced LV deformation and right ventricular (RV) fractional area change in non-MM patients. Conclusions: Early cardiac responses after HSCT were heterogeneous and compartment-specific, supporting multiparametric imaging for detection of subclinical cardiac adaptation.