Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder that leads to fibrosis of the skin and internal organs. Fragmented QRS (fQRS) is an important electrocardiogram (ECG) finding which is related to myocardial fibrosis. This study aims to evaluate the effect of fQRS on ejection fraction (EF) and other echocardiographic parameters in individuals diagnosed with SSc.

Methods: This was a retrospective cohort study including 52 patients with fQRS as the case group and 60 patients without fQRS as the controls. The characteristics and echocardiographic parameters of the patients from a minimum of three-year interval were recorded. All the data were compared between the two groups with the SPSS software version 20.0 for Windows.

Results: There were no significant differences in demographics, paraclinical results, and echocardiographic parameters including average ejection fraction, pulmonary hypertension, and tricuspid regurgitation velocity between cases and controls at the beginning and the end of the follow-up.

Conclusion: FQRS is considered to have no significant effect on EF and other echocardiographic parameters over at least a three-year interval in SSc patients. However, additional research with longer periods of follow-up and larger sample sizes is needed to completely recognize their association.

Background: Heart failure (HF) and chronic kidney disease (CKD) frequently coexist and contribute to poor clinical outcomes, particularly in patients with diabetes mellitus. The modifying effect of diabetes on the association between renal markers and left ventricular ejection fraction (LVEF) remains poorly understood.

Objective: To investigate whether diabetes modifies the relationship between renal biomarkers and LVEF in hospitalized patients with HF.

Methods: We conducted a cross-sectional analysis involving 112 patients diagnosed with HF who were admitted to a tertiary care hospital. Data were extracted from electronic medical records, including demographic characteristics, comorbidities, laboratory values, and echocardiographic assessments. The primary outcome was LVEF, as determined by transthoracic echocardiography. Renal function was evaluated using serum urea, creatinine, hemoglobin, and estimated glomerular filtration rate (eGFR). To examine whether the association between these renal markers and LVEF differed based on diabetes status, we fitted multiple linear regression models including interaction terms between diabetes and each renal marker. All models were adjusted for age, sex, and HF subtype (HFpEF, HFmrEF, or HFrEF).

Results: In multivariate models both urea and creatinine remained significantly associated with LVEF, with p-values of 0.007 and 0.005, respectively. Hemoglobin and eGFR did not show significant main effects in both unadjusted and adjusted models. In moderation analysis, a significant interaction was found between diabetes and urea (p = 0.022). Among diabetics, increase in urea was associated with a significant reduction in LVEF (p = 0.022), whereas the association was attenuated in non-diabetics. Similarly, the interaction between creatinine and diabetes was significant (β = −13.12, p = 0.003). In contrast, the interaction between diabetes and eGFR approached significance (β = 0.11, p = 0.076). No significant interaction was found for hemoglobin and diabetes (β = −0.70, p = 0.67).

Conclusion: Diabetes modifies the relationship between renal function and systolic performance in HF patients. The stronger associations of urea and creatinine with reduced LVEF in diabetic individuals highlight the importance of tailored risk assessment in the context of cardiorenal-metabolic disease.

Background: Cardiovascular complications account for a substantial proportion of perioperative complications. This study aims to evaluate whether preoperative high-dose atorvastatin reduces postoperative changes in serum high-sensitivity cardiac troponin (hs-cTn) concentrations in patients at elevated cardiac risk undergoing non-cardiac surgery.

Methods: In this triple-blinded, parallel-group, randomized controlled trial, adults with Revised Cardiac Risk Index (RCRI) ≥ 1 scheduled for non-cardiac surgery were randomized (1:1) to receive atorvastatin 80 mg 24 hours preoperatively or placebo. The primary outcome was the change in serum hs-cTn concentrations 24 hours after surgery. Secondary outcomes included the incidence of major adverse cardiovascular events (MACE; myocardial infarction, heart failure, stroke, or cardiovascular death) within seven days after surgery, as well as all-cause mortality and postoperative arrhythmia.

Results: A total of 112 patients with similar baseline characteristics were evenly randomized and completed a seven-day follow-up. Postoperative hs-cTn levels increased significantly in the placebo group (p < 0.001) but decreased in the statin group (p < 0.001), with a significant between-group difference favoring statin therapy (p < 0.001). Subgroup analyses by anesthesia type and prior statin use showed consistent findings. MACE occurred in three patients (5.4%) in the statin group and three patients (5.4%) in the placebo group (p = 1.000).

Conclusions: Preoperative high-dose atorvastatin significantly reduced postoperative hs-cTn, indicating a biochemical cardioprotective effect, but did not translate into a reduction of short-term clinical cardiovascular events. Larger multicenter trials with longer follow-up are required to determine whether troponin reduction translates into improved clinical outcomes.

Background: Percutaneous Coronary Intervention (PCI) is a cornerstone in the management of obstructive coronary artery disease. The Gensini score quantitatively assesses the severity and complexity of coronary lesions. The Residual Gensini Score (rGensini), measured after PCI, may offer superior prognostic information compared to the baseline score. This study aims to investigate the association between the rGensini and cardiac mortality.

Methods: In this study, all consecutive patients who did register for follow-up at the Afshar hospital's health promotion center within 30 days post-PCI were included. The primary outcome was cardiac mortality. Baseline characteristics, comorbidities (diabetes, hypertension, dyslipidemia, prior cardiac history), smoking status, family history, coronary dominance pattern, and coronary calcification were recorded. Patients were stratified into four risk categories based on rGensini: Zero-risk (0), Low-risk (0< to ≤11), Moderate-risk (>11 to ≤37), and High-risk (>37). Survival analysis was performed using the Kaplan-Meier method, and independent predictors of cardiac mortality were identified using Cox proportional hazards regression.

Results: The study included 141 patients (85 men, 56 women) with a mean age of 60.67 years. The mean baseline Gensini score was 31.22, which was reduced to a mean rGensini of 18.20 post-PCI. Over a mean follow-up of 264.1 days (range: 90-365 days), 10 cardiac deaths occurred. Kaplan-Meier curves demonstrated a significant gradation in survival probability across the strata. Multivariable Cox regression analysis identified rGensini category, age, coronary calcification, diabetes and hypertension as independent predictors of cardiac mortality.

Conclusion: The Residual Gensini Score is a powerful independent predictor of cardiac mortality following PCI.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical entity characterized by evidence of myocardial infarction (MI) in the absence of obstructive coronary artery disease (CAD) on angiography. This study aims to explore and visualize the global research trends and hotspots of MINOCA using bibliometric approaches.

Methods:  The search was performed in July 1, 2025 using the keyword ‘MINOCA’ and its synonyms. MINOCA-related articles were obtained from the Scopus database and analyzed using RStudio (version 4.5.0), employing the Bibliometrix package (via Biblioshiny) alongside VOSviewer (version 1.6.20) for bibliometric visualization.

Results: A total of 1694 publications related to MINOCA were identified, showing a marked increase in output over the past decade. The mean citations per article were 19.25, with the highest citation count being in 2018. ‘Frontiers in Cardiovascular Medicine’ published the most articles, while H.R. Reynolds was the most contributing author. The United States and China emerged as leading contributors. High-impact articles primarily focused on the pathophysiology, diagnostic algorithms, and prognosis of MINOCA. Keyword analysis revealed evolving research hotspots, including pathophysiology, cardiac magnetic resonance (CMR), coronary microvascular dysfunction, plaque disruption, and sex differences, indicating a growing focus on precision diagnostics and patient-tailored management strategies in MINOCA research.

Conclusion: The research landscape of MINOCA has expanded significantly, with growing attention to its underlying mechanisms and diagnostic challenges. Future studies should prioritize standardized diagnostic criteria and tailored therapeutic approaches. This bibliometric analysis provides a valuable framework for clinicians and researchers to navigate the evolving field of MINOCA.

Background: Pregnancy in pulmonary hypertensive female patients is strongly contraindicated because of the high mortality rate according to physiological changes, especially in peri- and postpartum periods, and in case of occurrence, termination at an early stage is recommended. Therefore, our experience with continued pregnancies in patients with pulmonary hypertension are scarce.

Case presentation: This case report presents a young woman diagnosed with multiple bilateral pulmonary hydatid cysts and right ventricular hydatid cyst, who underwent surgical and pharmacologic treatments, but developed pulmonary hypertension due to pulmonary artery obstruction eight years after. According to the unsuitable condition of the patient for surgery, she was a candidate for medical therapy, including Tadalafil, Bosentan, and Eplerenone. After 3 years, despite the advice to avoid pregnancy, the patient got pregnant and at 37 weeks underwent a successful emergent cesarean section due to maternal dyspnea and tachycardia.

Conclusions: We believe that prompt treatment and regular follow-ups in a tertiary care center with a multidisciplinary approach would be crucial in the management of pulmonary hypertensive patients who get pregnant.

Infective endocarditis (IE) is an under-recognized cause of fever that is often missed in preliminary evaluation. This may stem from a lack of vigilance towards IE and using empirical antibiotic therapy to treat fever. As a result, patients often present with complications of IE that warrant surgical intervention. We hereby discuss a case of IE that remained undiagnosed for 2 years, receiving short courses of oral antibiotic therapy for recurrent fever, ultimately developing heart failure due to valve perforation.

Gallbladder and biliary tract diseases may manifest as cardiac symptoms, ischemic ECG changes, and arrhythmias. Although rare, bradyarrhythmia cases induced by cardiobiliary reflex have been linked to acute cholecystitis. This case emphasizes the cardiobiliary reflex as a possible cause of bradyarrhythmia in patients with gallbladder and biliary tract diseases . 

Background: In-stent restenosis (ISR) following percutaneous coronary intervention (PCI) is an unwanted complication in some patients. The etiology is multifactorial, and identifying these factors may help improve long-term outcomes after PCI.

Case summary: We hereby describe two cases of recurrent ISR; case 1 describes the techniques of PCI used over 17 years to manage recurrent ISR of Left Main bifurcation disease, while case 2 highlights the role of coronary artery bypass grafting (CABG) as a treatment modality for recurrent ISR of the right coronary artery.

Discussion: Management of post-PCI recurrent ISR has witnessed multiple advancements over the past decade. Newer technologies like intravascular imaging, plaque or calcium modification techniques, and drug-eluting balloons enable effective management of recurrent ISR.  This article describes possible risk factors for recurrent ISR and discusses various treatment strategies for its management.

Background: A sinus venous atrial septal defect (SVASD) is a type of congenital heart defect that predominantly involves an opening between the Superior Vena Cava (SVC) and the Right Upper Pulmonary Vein (RUPV). Surgical closure of SVASD has been the standard treatment; however, the surgical closure of SVASD is far more complex than mere ASD secundum reconstruction, and complications are more likely. Transcatheter closure of SVASD is an emerging alternative for surgical repair.

Methods: We report five cases of successful transcatheter closure of SVASD and one case of failure that required surgical intervention. All patients underwent pre-procedure Computed Tomography Angiography (CTA) to determine the size and location of the defect and the optimal stent size and position. The SVC stenting was performed using balloon-expandable stents, followed by RUPV angioplasty if needed.

Results:  Final angiograms and pressure measurements in the SVC, RUPV, and Right Atrium (RA) confirmed the absence of residual shunt and pulmonary venous obstruction. One patient experienced stent migration to the pulmonary artery, which necessitated surgical retrieval and defect closure.

Conclusion: The balloon expansion test is not mandatory before stent implantation, as in the case of RUPV obstruction, its flow could be reestablished by ballooning and/or stent implantation within the RUPV with a mild residual shunt which might resolve spontaneously.

C syndrome is a rare heterogeneous malformation syndrome involving multiple organs. Coexistence of tetralogy of Fallot (TOF) and Agenesis of Corpus Callosum (ACC) rarely been reported in C syndrome patients, previously. Agenesis of corpus callosum is a rare disorder that is present at birth and is characterized by a partial or complete absence of the corpus callosum. Patients with this disorder usually present with microcephaly and a wide range of callosal anomalies from thinning to complete agenesis. It has been thought to be a very rare condition, its diagnosis may be incidental but the increased use of neuro-imaging techniques, such as MRI, is resulting in an increased rate of diagnosis. This condition may also be identified during pregnancy through an ultrasound. In this article, we report a 1-year-old infant with tetralogy of Fallot  was diagnosed in fetal period and neurodevelopmental delay who was diagnosed with agenesis of corpus callosum after birth, underwent surgical TOF correction and receives maintenance neurologic treatments. The importance of this case is the accompanying neurological disorders with congenital heart diseases, especially TOF. At the time of diagnosis of TOF in fetal echocardiography, if corpus callosum agenesis is detected , parents have the possibility to decide on abortion. Although the patient’s heart disease is completely corrected, the patient’s developmental disorder can not be corrected.

Background: "Myxedema" crisis, which occurs due to hypothyroidism, was a rare and life-threatening condition and led to severe myocardial infarction and lethal arrhythmia, which was presented in this case.

    Case Presentation: A 63-year-old man had symptoms of typical prolonged chest pain, palpitation leading to near syncope, severe fatigue, loss of appetite, dizziness, and sleepiness two days before admission. The patient had somnolence, hypotension, thin eyebrows, and pretibial pitting edema. Electrocardiography revealed sinus rhythm with prolonged QT interval, inferolateral-anterior ischemia, and an increase of five times troponin-T value. Therefore, the working diagnosis was non-ST elevation myocardial infarction (NSTEMI) Killip IV, severe biventricular heart failure, severe acute kidney injury, and severe acute liver injury. On the third day of treatment, patient had two consecutive unstable ventricular tachycardia and one-time return of spontaneous circulation (ROSC) cardiac arrest. Thyroid examination incidentally revealed severe hypothyroidism with severe hyperkalemia. After other causes had been excluded, the diagnosis of "myxedema" crisis was assumed. Oral thyroid therapy, levothyroxine 100 mcg once daily, was given. Within 3 days of all treatment, the patient experienced significant hemodynamic improvement, improvement in kidney function, and normalization of liver function, accompanied by the disappearance of dyspnea, chest pain, and edema, with a compos mentis status. The patient was discharged with stable hemodynamics without support on the tenth day of treatment and underwent a coronary scan at an outpatient facility with near-normal coronary results. The patient has been on routine control for almost a year with levothyroxine 50 mcg thyroid therapy once daily and has recently demonstrated good left ventricular (LV) function (EF 50%) and a good exercise test functional capacity.  

   Conclusion: Clinicians should be aware of the differential diagnosis of hypothyroidism crisis as the etiology of myocardial infarction, heart failure, and lethal arrhythmia, and treatment should be started immediately.

I read with great interest the recent article by Taskin Yilmaz et al. (Vol. 20, No. 2, 2025) examining the association between health literacy and treatment adherence among elderly patients with hypertension. The authors’ findings—particularly the significant relationship between both functional and communicative health literacy scores and improved blood pressure control—provide valuable evidence for refining patient-centered educational strategies.

I would like to highlight two practical points and offer one suggestion for future research. First, the authors reported that media exposure and active search for health information were linked to better blood pressure control. This observation suggests that community-based educational modules—such as short instructional videos tailored for older adults and family-centered counseling sessions—could be implemented and evaluated as adjuncts to routine care. Second, given the cross-sectional design of the study, causal inference remains limited. Potential confounders such as cognitive status and social support may also influence both literacy and adherence. Incorporating brief cognitive screening tools (e.g., Mini-Cog) and validated social-support scales in future studies would help clarify whether health literacy acts as an independent mediating factor.

Finally, I recommend evaluating a structured low-literacy educational package delivered during hospitalization and reinforced through nurse-led telephone follow-up. This model is practical, scalable, and allows measurable outcomes in blood pressure control within three months, potentially improving quality of life while reducing the burden on healthcare systems.

Objective: Coronary Slow Flow Phenomenon (CSFP) involves delayed coronary artery filling without obstruction and is associated with angina and myocardial ischemia. This meta-analysis assessed the link between CSFP and impaired Left Ventricular Global Longitudinal Strain (LVGLS), a marker of subclinical myocardial dysfunction.

Methods: A systematic search (PubMed, Embase, Scopus up to January 2025) identified 18 observational studies comparing LVGLS and layer-specific strain in CSFP patients versus controls with normal coronary flow.

Results: CSFP patients showed significantly reduced LVGLS vs. controls (SMD: 1.22, 95% CI: 0.69 to 1.75). Layer-specific analysis revealed impairment across all myocardial layers, most pronounced in the endocardium (SMD: 0.79, 95% CI: 0.21 to 1.38). While LVEF was preserved, LVGLS demonstrated moderate-to-high diagnostic accuracy for CSFP (AUC: 0.80, 95% CI: 0.66 to 0.95). Reduced LVGLS independently predicted CSFP (adjusted OR: 1.43, 95% CI: 1.19 to 1.46). Exercise stress effects on LVGLS were inconsistent.

Conclusions: CSFP is associated with impaired LVGLS, particularly in the endocardial layer, despite preserved LVEF. LVGLS may serve as a noninvasive marker for subclinical dysfunction in CSFP.