This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.

Balloon-assisted detection and treatment of the origin of saccular aneurysms in ivy-like coronary arteries - Turkish Journal of Thoracic and Cardiovascular Surgery

Symptomatic bradycardia can lead to systemic hypoperfusion and hemodynamic instability, particularly in patients with advanced conduction system disease. This study aimed to identify factors associated with perfusion impairment in patients experiencing persistent symptomatic bradycardia who required permanent pacemaker implantation. In this single-center retrospective observational study, 299 patients who underwent pacemaker implantation between December 2021 and June 2025 were screened, resulting in the inclusion of 166 patients with persistent symptomatic bradycardia. Patients were stratified based on the presence of perfusion impairment, defined using specific clinical, biochemical, and organ-specific criteria. We analyzed clinical, laboratory, electrocardiographic, and echocardiographic parameters obtained prior to pacing. Perfusion impairment was identified in 70 patients, who were older and exhibited lower heart rates and blood pressures, elevated lactate levels, a higher incidence of renal dysfunction, and increased inflammatory markers. Multivariable analysis revealed that age (odds ratio [OR] 1.097; p = 0.001), heart rate (OR 0.910; p = 0.022), and high-grade atrioventricular (AV) block (OR 7.546; p = 0.002) were independently associated with perfusion impairment. Receiver operating characteristic (ROC) analysis demonstrated moderate discrimination for age and heart rate, while the multivariable model displayed improved discrimination. Our findings indicate that advanced age, lower baseline heart rate, and high-grade AV block are correlated with perfusion impairment in patients with persistent symptomatic bradycardia requiring pacemaker implantation. Early identification of this high-risk subgroup may facilitate timely monitoring and intervention.