Contrast-induced nephropathy (CIN) is a serious complication in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Early identification of high-risk patients is essential to improve outcomes and reduce mortality. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was originally designed to predict mortality in heart failure patients, but its role in predicting CIN has not been fully explored. In the present retrospective study, 1403 STEMI patients treated with pPCI were analyzed. Those who developed CIN had higher mortality, longer hospital stays, and more comorbidities. The MAGGIC score and 21 clinical parameters were incorporated into deep learning (DL) models, including multilayer perceptrons, TabNet, TabTransformer, and Kolmogorov-Arnold Networks (KAN) and one machine learning algorithm such as logistic regression. The best-performing model, KAN, significantly improved CIN prediction with an area under curve (AUC) of 0.92. SHapley Additive exPlanations (SHAP) analysis revealed key predictors such as pain-to-balloon time, contrast volume, baseline creatinine, and MAGGIC score. Our findings demonstrate that combining MAGGIC risk scoring with DL substantially enhances CIN prediction in STEMI patients. This approach enables identification of at-risk individuals and supports implementation of nephroprotective strategies at an early stage. The web-based calculator may assist clinical decision making.

Background Permanent pacemaker implantation is an established treatment for both sick sinus syndrome (SSS) and atrioventricular block (AVB), yet limited data exist comparing long-term clinical outcomes and cardiac remodeling patterns between these distinct bradyarrhythmic etiologies. Objectives To compare three-year clinical outcomes and cardiac structural changes between SSS and AVB patients following permanent pacemaker implantation. Methods This retrospective observational study enrolled 192 adult patients (65 SSS, 127 AVB) who underwent pacemaker implantation between January 2018 and December 2020. Demographic data, echocardiographic parameters, pacemaker-recorded data, and clinical outcomes were assessed at baseline, one month, six months, one year, and three years. Primary outcomes included changes in cardiac structure and function, symptomatic improvement, new-onset atrial fibrillation, rehospitalization, and all-cause mortality. Results Both groups demonstrated significant declines in left ventricular ejection fraction over three years (SSS: 57.2±6.0% to 54.3±8.3%, p<0.001; AVB: 55.5±7.0% to 53.0±6.8%, p<0.001). Despite similar ventricular dysfunction progression, distinct remodeling patterns emerged: SSS patients exhibited significant increases in left atrial diameter (31.3 to 38.8 mm, p=0.040), left ventricular end-diastolic diameter (45.2 to 51.0 mm, p90%). Symptomatic improvement was comparable (SSS: 85.6% vs. AVB: 83.5%, p=0.84), as were new-onset atrial fibrillation (41.5% vs. 37.0%, p=0.54), rehospitalization (50.8% vs. 58.3%, p=0.38), and all-cause mortality (13.8% vs. 11.8%, p=0.69). Mortality predictors differed: mitral regurgitation severity in SSS versus coronary artery disease, beta-blocker therapy, and left atrial volume in AVB patients. Conclusions Despite similar symptomatic benefits and clinical outcomes, SSS and AVB patients demonstrate distinct cardiac remodeling patterns and different mortality predictors, supporting the need for etiology-specific follow-up strategies in pacemaker recipients.

Mechanical heart valve replacement necessitates long-term warfarin anticoagulation to prevent thromboembolic complications, yet achieving adequate anticoagulation control remains challenging. This study evaluated whether mean platelet volume (MPV) could serve as a biomarker for anticoagulation quality in mechanical heart valve recipients. We conducted a retrospective longitudinal cohort analysis of 370 patients with mechanical heart valves receiving warfarin therapy. MPV and international normalized ratio (INR) were measured at 5 time points. Time in therapeutic range (TTR) was calculated using the Rosendaal method, with effective anticoagulation defined as TTR ≥60%. Correlations between MPV, INR, and TTR were analyzed overall and stratified by valve type. Only 34.1% of patients achieved effective TTR. Mean MPV was 10.31 ± 1.04 fL and mean INR was 2.79 ± 0.54. No significant correlation was identified between MPV and TTR. However, patients with mean INR ≤3.0 exhibited significantly higher MPV values than those with INR >3.0 (10.40 vs. 10.13 fL). Subgroup analysis revealed a significant inverse correlation between MPV and INR in patients with mitral valve replacement but not in patients with aortic valve replacement, with temporal variation across measurement periods. MPV showed poor discriminatory ability for predicting effective TTR. Multivariable regression identified atrial fibrillation, older age, higher platelet counts, and higher hemoglobin as independent predictors of effective TTR, while MPV showed no independent association. In conclusion, MPV does not serve as a reliable biomarker for anticoagulation quality in patients with mechanical heart valve. Enhanced anticoagulation management strategies are needed to improve TTR in this high-risk population.

Objectives: The aim of the study to evaluate the safety and efficacy of the transthoracic echocardiography (TTE) guided secundum atrial septal defect (ASD) closure without balloon sizing, sedation or general anesthesia in adults.Methods: We retrospectively evaluated 200 secundum ASD closure patients in the tertiary cardiology center. Transesophageal echocardiography (TEE) was performed to all the patients at least one day before the intervention by the procedure operators. The patients who were closed with a cribriform device, using more than one device, with insufficient rim (<5 mm) (other than the anterior superior rim (aortic rim)), totally flail, and complex interatrial septum anatomy were excluded from the analysis.The size of the ASD closure device was chosen according to the largest diameter measured by TEE. ASD device was selected as 4 mm larger in patients without anterior superior rim and 2 mm larger in other patients than the largest diameter measured in 2D-TEE.Results: In the remaining 166 patients, the procedure was performed with TTE and fluoroscopy guidance without balloon sizing, sedation or general anesthesia. The procedure was performed through right femoral vein. The patients age: 38.56 ± 14.72, gender: 57 male, 109 female, ASD size: 18.88 ± 5.99 mm, anterior superior rim: 5.30 ± 4.04 mm, anterior inferior rim: 14.22 ± 6.46 mm, posterior superior rim: 17.16 ± 4.96 mm, posterior inferior rim: 16.67 ± 7.48 mm. ASD device size: 23.74 ± 6.59 mm. The procedure success rate was 98.1% (163 patients). The complications; 1 patient device embolised, 2 patients device was not placed in the correct position by TTE.Conclusions: TTE and fluoroscopy-guided secundum ASD closure without balloon sizing, sedation or general anesthesia by experienced operators is a safe and effective procedure.

Introduction: Left bundle branch block (LBBB) complicates electrocardiographic interpretation in acute heart failure (AHF). This study aimed to evaluate the relationship between electrocardiographic parameters, including QRS duration, QRS morphology, and the Selvester QRS score (SQS), and echocardiographic findings in patients with AHF presenting with LBBB across different heart failure phenotypes. Methods: In this retrospective cohort, 275 patients hospitalized with AHF and LBBB were analyzed. Patients were classified as heart failure with reduced ejection fraction (HFrEF, left ventricular ejection fraction [LVEF] <40%), heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 40–49%), or heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%). Associations between electrocardiographic (ECG) and echocardiographic parameters were evaluated using Spearman correlation and multivariable regression. Discriminatory performance for reduced systolic function was assessed by receiver operating characteristic (ROC) analysis. Results: Mean age was 61.7 ± 13.8 years and 70.5% were male; median LVEF was 40% (IQR: 27–48%). HFrEF was present in 49.8%. Among ECG indices, only SQS correlated significantly with echocardiographic measures: LVEF (r = −0.447), left ventricular end-diastolic diameter (LVEDD, r = 0.346), left ventricular end-systolic diameter (LVESD, r = 0.373), and LV mass index (r = 0.205) (all p < 0.001). In multivariable analysis, SQS (OR = 1.373, 95% CI: 1.255–1.501, p < 0.001) and LV mass index independently predicted HFrEF. The Hosmer-Lemeshow test confirmed adequate calibration (p = 0.49). ROC analysis showed SQS had moderate discriminatory ability (area under the curve [AUC] 0.768, 95% CI: 0.711–0.825), with an optimal cutoff >43 yielding 74.5% sensitivity and 69.6% specificity. QRS duration and morphology demonstrated no meaningful predictive value (AUC ≈ 0.49). Conclusion: In AHF patients with LBBB, SQS outperforms conventional QRS metrics in identifying reduced LV systolic function. An SQS >43 provides moderate diagnostic accuracy and may support early risk stratification when echocardiography is not immediately available.