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- MakaleAçık Erişim2026Scopus SJRQ4Prognostic Value of Myocardial Contraction Fraction for One-Year Cardiac Death After Transcatheter Aortic Valve Implantation in Severe Aortic Stenosis: A Simple Echocardiographic Metric for High-Risk Stratification; [Miyokard Kontraksiyon Fraksiyonunun Prognostik Değeri: Yüksek Riskli Hastaların Belirlenmesinde Basit Bir Ekokardiyografik Ölçüt]
Coşkun, Şenol; Mirzamidinov, Didar; Karaüzüm, Kurtuluş; Tiryakioğlu, Selma Kenar; Şahin, Tayfun; Kılıç, Teoman
Objective: Myocardial contraction fraction (MCF) is a volumetric index of myocardial shortening that relates left ventricular stroke volume to myocardial volume. In patients with severe aortic stenosis (AS), left ventricular ejection fraction (LVEF) may remain preserved despite advanced myocardial remodeling. This study aimed to evaluate the prognostic value of MCF for predicting 1-year cardiac death in patients undergoing transcatheter aortic valve implantation (TAVI). Method: This retrospective, single-center study included 419 consecutive patients with severe AS who underwent TAVI at a tertiary center. MCF was calculated by dividing stroke volume by left ventricular myocardial volume and multiplying the result by 100. Left ventricular myocardial volume was derived by dividing left ventricular myocardial mass by the myocardial density, which was assumed to be 1.05g/mL. The primary endpoint was 1-year cardiac death. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal MCF cutoff value, and the patients were divided into low- and high-MCF groups according to this threshold. Results: The ROC-derived MCF cutoff value for predicting 1-year cardiac death was 24, with an area under the curve of 0.783 (95% CI, 0.716-0.851), a sensitivity of 78.1, and a specificity of 71.8. Patients with MCF≤24% had lower LVEF and stroke volume index values, higher myocardial mass index and pulmonary artery pressure values, and larger left ventricular diameters than those with MCF>24%. One-year cardiac death occurred in 32 patients (7.6%) and was significantly more frequent in the MCF≤24% group than in the MCF>24% group (18.7% vs. 2.5%; P < 0.001). In univariable Cox regression analysis, MCF≤24% was strongly associated with 1-year cardiac death. In multivariable analysis, higher MCF, evaluated as a continuous variable, remained independently associated with a lower risk of 1-year cardiac death. Conclusion: Reduced MCF was associated with adverse left ventricular remodeling and increased 1-year cardiac death after TAVI. MCF may provide additional prognostic information beyond conventional echocardiographic parameters in patients with severe AS undergoing TAVI.
- MakaleAçık Erişim2026Scopus SJRQ1Comparison of safety and short-term outcomes of septostomy and direct tunnel passage techniques in percutaneous patent foramen ovale closure: a multicenter experience
Coskun, Senol; Tiryakioğlu, Selma Kenar; Mirzamidinov, Didar; Inan, Duygu; Kilicgedik, Alev; Sahin, Tayfun; Kilic, Teoman
Background – Percutaneous closure of a patent foramen ovale (PFO) is an established therapeutic strategy for patients with cryptogenic stroke (CS). This study aimed to compare the procedural safety, efficacy, and short-term clinical outcomes of atrial septostomy vs. standard direct tunnel passage techniques for PFO closure. Methods – We retrospectively analyzed consecutive patients who underwent PFO closure for CS at four centers between January 2010 and December 2020. Demographic characteristics, vascular risk factors, Risk of Paradoxical Embolism (RoPE) scores, PFO anatomical features, procedural details, and clinical outcomes were compared between patients treated with atrial septostomy and those undergoing direct tunnel passage. Continuous variables are presented as mean ± standard deviation or median [interquartile range], and categorical variables as counts and percentages. Results – A total of 246 patients were included (mean age 40.5 ± 9.8 years), of whom 69.9% presented with ischemic stroke and 30.1% with transient ischemic attack (TIA). Atrial septostomy was performed in 106 patients (43.1%), while 140 patients (56.9%) underwent direct tunnel passage. Baseline clinical characteristics were comparable between groups; however, the septostomy group exhibited significantly more complex PFO anatomy, including atrial septal aneurysm (69.8% vs. 39.3%), septal hypermobility (62.3% vs. 34.3%), and spontaneous shunting at rest (85.8% vs. 50.7%; all p < 0.001). Procedure duration was similar between groups (41.1 ± 10.2 vs. 40.7 ± 13.8 min; p = 0.83), and technical success was achieved in nearly all cases. No major procedural complications occurred. Minor adverse events were infrequent and comparable (8.4% vs. 4.3%; p = 0.20). At six-month follow-up, residual shunt rates were numerically lower in the septostomy group (6.6% vs. 11.4%; p = 0.27). No TIAs were observed in the septostomy group, whereas a 3.6% incidence was noted in the direct passage group (p = 0.08). New-onset atrial arrhythmia occurred in two patients (1.9%) in the septostomy group and in none of the direct passage group (p = 0.18). Conclusion – Despite being applied in patients with more complex PFO anatomy, atrial septostomy demonstrated comparable procedural safety, technical success, and short-term efficacy to standard direct tunnel passage. Tunnel length emerged as an independent predictor of residual shunt, regardless of closure technique. In experienced centers, atrial septostomy appears to be a safe and practical alternative for anatomically challenging PFO closures.
