Background and Objectives: Red cell distribution width–standard deviation (RDW-SD) has been associated with systemic inflammation and adverse cardiovascular outcomes, but its relationship with the angiographic severity and morphological complexity of drug-eluting stent-in-stent restenosis (ISR) has not been systematically characterized. The present study investigated whether RDW-SD is associated with angiographic restenosis severity and restenotic lesion complexity, and compared its performance with the platelet distribution width (PDW), Metabolic Stress Index (MSI), and Platelet-to-HDL Ratio (PHR). Materials and Methods: In this retrospective single-center observational study, 290 patients undergoing clinically indicated repeat coronary angiography following prior drug-eluting stent (DES) implantation were enrolled. Angiographic luminal narrowing was quantified by QCA and categorized as reference (<50% in-stent luminal narrowing; n = 111), intermediate ISR (50–69%; n = 76), and severe ISR (≥70%; n = 103). The Mehran classification was applied to patients with ISR ≥50% and dichotomized as Mehran class I–II (n = 91) vs. Mehran class III–IV (n = 70). Multivariable logistic regression, hierarchical modeling, and incremental discrimination analyses (IDI and NRI) were performed for both binary outcomes. Results: RDW-SD differed significantly across angiographic severity groups (Kruskal–Wallis H = 51.14, p < 0.001), being highest in the ISR ≥70% group [44.6 fL (IQR 43.8–45.3)] and lowest in the ISR 50–69% group [43.2 fL (42.7–43.7)]. A parallel pattern was observed across Mehran class (H = 50.57, p < 0.001; Mehran class III–IV: 44.9 fL [44.2–45.8]). In multivariable analysis, RDW-SD independently associated with ISR ≥70% (OR = 1.228 per 0.5 fL, 95% CI 1.122–1.344, p < 0.001) and Mehran class III–IV (OR = 1.274, 95% CI 1.155–1.406, p < 0.001). Hierarchical modeling showed that adding RDW-SD improved the AUC from 0.603 to 0.719 for ISR ≥ 70% and from 0.592 to 0.757 for Mehran class III–IV (LRT p < 0.001 for both), with incrementally larger IDI and NRI gains for the Mehran class III–IV outcome. PDW did not retain significance after adjustment; MSI and PHR were not significantly associated with either outcome. Conclusions: RDW-SD was independently associated with both angiographic ISR severity and Mehran morphological complexity in patients with established drug-eluting stent restenosis, with numerically greater model discrimination for the Mehran class III–IV endpoint. These findings suggest that RDW-SD may provide complementary information regarding restenosis burden and complexity in patients with established ISR. Prospective studies are required to validate these observations and determine their clinical relevance.

Background: Nutritional impairment has been associated with adverse outcomes in acute coronary syndrome (ACS), yet its relationship with the no-reflow phenomenon remains incompletely understood. We aimed to compare the performance of the Hemoglobin–Albumin–Lymphocyte–Platelet (HALP), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) scores for no-reflow assessment in patients with ACS. Methods: This prospective single-centre study included 279 consecutive patients with ACS undergoing percutaneous coronary intervention. HALP, PNI, and CONUT scores were calculated from admission laboratory parameters. No-reflow was defined as post-procedural TIMI flow grade ≤ 2 in the absence of mechanical obstruction, with myocardial blush grade used in equivocal cases. Hierarchical logistic regression, receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), decision curve analysis, and bootstrap validation were performed. Results: No-reflow occurred in 46 patients (16.5%). All three nutritional indices were significantly associated with no-reflow (all p < 0.001). In multivariable analysis, only the CONUT score remained independently associated with no-reflow (OR 1.728, 95% CI 1.226–2.435, p = 0.002). The addition of nutritional indices to the clinical model improved discrimination, increasing the area under the curve from 0.649 to 0.693 for HALP, 0.733 for PNI, and 0.770 for CONUT. CONUT provided the largest likelihood-ratio improvement (χ² = 25.98, p < 0.001), NRI (0.757, p < 0.001), and IDI (0.104, p < 0.001). Pairwise DeLong comparisons showed no statistically significant differences among the nutritional models. Internal validation of the CONUT model demonstrated good discrimination and calibration (bootstrap-corrected AUC 0.754). Conclusions: Among the evaluated nutritional indices, CONUT showed the largest incremental improvement in model performance; however, statistically significant superiority over HALP and PNI was not demonstrated. These findings should be considered as exploratory and require confirmation in larger multicentre studies.

Takayasu arteriti, aorta ve ana dallarını tutan kronik inflamatuvar bir vaskülit olup, nadiren koroner arter anomalileri ile birlikte görülebilmektedir. Koroner arter fistülleri ise çoğunlukla konjenital kökenli olmakla birlikte, inflamatuvar süreçlere bağlı olarak edinsel şekilde de gelişebilen nadir vasküler anomalilerdir. Takayasu arteriti ile koroner arter fistülü birlikteliği oldukça seyrek bildirilmiş olup, klinik önemi fistülün oluşturduğu hemodinamik yük ile ilişkilidir. Bu olgu sunumunda, Takayasu arteriti tanısı ile izlenen 60 yaşındaki kadın hastada saptanan ve sirkumfleks arterden köken alarak pulmoner artere drene olan semptomatik koroner arter fistülünün tanısal süreci ve perkütan tedavisi sunulmaktadır. Hastada non-invaziv değerlendirmeler sonrası yapılan BT koroner anjiyografi ile fistül şüphesi ortaya konmuş, invaziv koroner anjiyografi ile tanı doğrulanmıştır. Semptomatik olması nedeniyle planlanan transkateter coil embolizasyonu işlemi, mikrokateter aracılığıyla gerçekleştirilen çoklu coil yerleştirilmesi ile başarıyla tamamlanmış ve fistülde tam oklüzyon sağlanmıştır. İşlem sonrası dönemde herhangi bir komplikasyon izlenmemiştir. Bu olgu, Takayasu arteriti zemininde gelişen nadir bir koroner arter fistülünü göstermesi ve perkütan coil embolizasyonunun etkinliğini ortaya koyması açısından dikkat çekicidir. Takayasu arteritis is a chronic inflammatory vasculitis affecting the aorta and its major branches and may rarely be associated with coronary artery abnormalities. Coronary artery fistulas are uncommon vascular anomalies that are predominantly congenital in origin but may also develop as acquired lesions secondary to inflammatory processes. The coexistence of Takayasu arteritis and a coronary artery fistula has been reported only rarely, and its clinical significance is primarily related to the hemodynamic burden imposed by the fistula. In this case report, we present the diagnostic evaluation and percutaneous treatment of a symptomatic coronary artery fistula originating from the circumflex artery and draining into the pulmonary artery in a 60-year-old woman with a known diagnosis of Takayasu arteritis. Following noninvasive assessment, coronary computed tomography angiography raised suspicion of a coronary fistula, which was subsequently confirmed by invasive coronary angiography. Due to the presence of symptoms, transcatheter coil embolization was planned and successfully performed using a microcatheter-guided deployment of multiple coils, resulting in complete occlusion of the fistula. No procedural or post-procedural complications were observed. This case is noteworthy because it demonstrates a rare coronary artery fistula associated with Takayasu arteritis and highlights the feasibility and effectiveness of percutaneous coil embolization as a treatment strategy.

Objective: Primary hyperparathyroidism (PHPT) has been associated with increased cardiovascular morbidity and mortality. Although conventional echocardiography is frequently used to evaluate cardiac function, it may fail to detect early myocardial changes. Speckle-tracking echocardiography (STE) provides greater sensitivity in identifying subclinical cardiac dysfunction. This study investigated systolic and diastolic functions of the left ventricle (LV) using STE in PHPT patients and examined their associations with clinical and biochemical variables. Methods: A total of 39 PHPT patients and 40 healthy controls were enrolled. PHPT diagnosis was based on elevated serum calcium and parathormone (PTH) levels, confirmed by imaging. Patients with comorbid conditions such as hypertension, diabetes, and chronic kidney disease were excluded. All individuals of patient and control groups were performed both conventional echocardiography and STE. Global longitudinal strain (GLS) and additional parameters of echocardiographic investigation were measured. Biochemical assessments included serum calcium level, phosphorus, 25-hydroxy vitamin D, and PTH levels. Statistical comparisons and correlation analyses were performed. Results: PHPT patients showed higher calcium, parathormone levels, and lower phosphorus and vitamin D levels than controls. GLS values were considerably lower in the PHPT group, indicating subclinical myocardial dysfunction despite intact ejection fraction (p < 0.05). GLS and levels of calcium, phosphorus, and PTH were found to be significantly correlated (p < 0.05). Conclusion: STE effectively detected early myocardial dysfunction in PHPT patients and demonstrated associations with biochemical markers. These results support the use of STE for early cardiac assessment in PHPT and underline the need for further studies to confirm these findings.

Background/Objectives: The triglyceride–glucose (TyG) index, a surrogate marker associated with insulin resistance, has been linked to both blood pressure elevation and circadian blood pressure dysregulation; however, its relationship with ambulatory blood pressure (BP) phenotypes across the full spectrum of contemporary ambulatory BP categories remains incompletely characterised. This study investigated the association of the TyG index with ambulatory BP categories and circadian BP phenotypes in untreated adults undergoing ambulatory blood pressure monitoring (ABPM). Methods: This retrospective cross-sectional study included 723 consecutive adults with no current or previous exposure to antihypertensive medication (treatment-naïve status refers exclusively to antihypertensive pharmacotherapy) who underwent 24 h ABPM and same-day laboratory assessment at a tertiary referral centre. Participants were classified according to the 2024 European Society of Cardiology ambulatory BP thresholds into non-elevated BP (n = 199), elevated BP (n = 243), or hypertension (n = 281) groups. Circadian BP phenotypes were categorised as extreme-dippers, dippers, non-dippers, and reverse-dippers. Associations between the TyG index and ambulatory BP categories were evaluated using multivariable proportional-odds ordinal logistic regression. The joint effect of BP category and circadian phenotype was examined by adding a TyG index × circadian phenotype interaction term to the ordinal model, and circadian phenotypes were characterised using multinomial logistic regression. Results: The TyG index increased progressively across ambulatory BP categories (8.8 ± 0.5, 9.1 ± 0.5, and 9.2 ± 0.6; p-trend < 0.001). After adjustment for age, sex, HbA1c, estimated glomerular filtration rate, and body mass index, each one-standard-deviation increase in the TyG index was associated with higher ambulatory BP category (OR 1.57, 95% CI 1.34–1.83; p < 0.001). The Brant test provided no evidence against the proportional-odds assumption (p = 0.379). In an exploratory analysis, the TyG–BP category association differed across circadian phenotypes (TyG × phenotype interaction, likelihood-ratio χ² = 8.26, df = 3, p = 0.041). In multinomial analysis, a higher TyG index was associated with the reverse-dipper (OR 2.90 per SD, 95% CI 2.06–4.08) and extreme-dipper (OR 2.77, 95% CI 1.87–4.10) phenotypes relative to the results for the dippers (both p < 0.001), but not with non-dipping (OR 1.02, 95% CI 0.84–1.24; p = 0.86) after multivariable adjustment. Conclusions: Among untreated adults undergoing ABPM, higher TyG index values were associated with progressively higher ambulatory BP categories and with reverse- or extreme-dipper circadian BP phenotypes after multivariable adjustment. Because insulin resistance was not measured directly, these results describe an association between the TyG index, a surrogate marker, and ambulatory BP phenotypes; they should be interpreted as hypothesis-generating because of the retrospective cross-sectional design. Prospective studies are warranted to determine their temporal and clinical significance.