Objective: Acute coronary syndrome patients should be closely followed-up to maintain
optimal adherence to medical treatments and to reduce adverse events. Digital health
interventions might provide improved outcomes for patient care by providing closer follow-
up, compared to standard care. Thus, in this meta-analysis, we aimed to evaluate the
effect of digital health interventions on follow-up in acute coronary syndrome patients.
Methods: We searched medical databases to obtain all relevant studies comparing digital
health interventions with standard care in acute coronary syndrome patients. After
reviewing all eligible studies, a meta-analysis was conducted with the remaining 11 randomized
controlled studies and 2 non-randomized controlled studies. A modified Jadad
scale and Newcastle-Ottawa scale were used to assess the quality of the publications
for randomized controlled studies and non-randomized controlled studies, respectively.
Results: This meta-analysis consisted of 7657 patients. The all-cause mortality rate was
49% lower in the digital health intervention cases, compared to those who received standard
care [relative risk (RR) = 0.51 (0.37; 0.70), P <.01]. There was a significant decrease in
systolic blood pressure in the digital health interventions group, compared to the standard
care group [mean difference = -5.28 (-9.47; -1.08), P =.01]. The rate of nonadherence
to anti-aggregant drugs was 69% lower in the digital health interventions than in the
standard care group [RR = 0.31 (0.20; 0.46), P <.01]. Also, nonadherence rates for statin
and beta-blockers were lower in the digital health interventions group. The risk of rehospitalization
was observed to be 55% less in the digital health interventions patients, compared
to the standard care group [RR = 0.45 (0.30; 0.67), P <.01].
Conclusion: Digital health interventions can be effective in follow-up for secondary prevention
in acute coronary syndrome patients.

Background: Although energy drinks have been consumed for many years, their effects on the cardiovascular system continue to be investigated. Today, the most frequently used area of energy drinks is the entertainment sector, and this study investigates the
effects of energy drinks and alcohol consumption on rats’ limb and myocardium tissue.
Methods: Forty Wistar Albino rats were used and divided into 4 groups. Energy drinks were given to the first group (the energy drink group), alcohol was given to the second group, and energy drinks and alcohol were given to the third group Redbull-Alcohol (RA). Blood samples, leg muscles, and heart tissues were studied after the ischemia–reperfusion model was created at the infrarenal level.
Results: In the histopathological examination of heart muscles, the damage was significantly more severe in the RA group than in the control group (P <.05). There was no significant change in the RA group in the limb muscle; however, muscle fiber abnormality was higher. The energy drink group was more prone to carbon dioxide retention and hypoxia, resulting in respiratory acidosis. (P =.05). Lactate was significantly higher in the energy drink group (P =.002). Glucose concentrations of energy drink and RA groups were higher (P =.02).
Conclusion: The high lactate values of the energy drink group and more damaged fibers in the striated muscles in the RA group showed that they are more susceptible to ischemia. Long-term energy drinks and alcohol use may cause damage to the heart muscle and endothelium. Also, the effects of long-term alcohol and energy drink use on the respiratory system should be investigated with more specific studies.

Background: Energy drinks contain caffeine, taurine, sucrose, vitamins, and other amino acids. The dosage of these varies depending on the drink chosen. Several studies on energy drinks have been carried out, but the results obtained are still inconsistent as well as the risk associated with consumption. This study analyzed the cardio- and cerebrovascular responses after consumption of an energy drink – RedBull® – under standardized pre- and post-ingestion conditions and its impact on the cardiovascular and cerebrovascular system.
Methods: A sample of 30 healthy young adult females was recruited and subjected to 3 moments of evaluation: at baseline, 30 minutes after ingesting the energy drink, and 60 minutes after ingesting it according to a non-randomized pre–post intervention study design.
Results: It is found that over time there are significant changes in peak systolic velocity (P =.006) and endodiastolic velocity (P <.001) of common carotid artery, peak systolic velocity (P =.007), and endodiastolic velocity (P <.001) of internal carotid artery, peak systolic velocity (P =.004), end endodiastolic velocity (P =.013) of the external carotid artery, endodiastolic velocity (P =.042) of the middle cerebral artery, cardiac output (P =.004), and heart rate (P <.001).
Conclusions: After the consumption of Redbull®, there was a decrease in the velocities of the carotid arteries and the middle cerebral artery as well as a decrease in cardiac output accompanied by a decrease in heart rate and a slight, although not significant, increase in systolic and diastolic blood pressures. However, it is still unclear which pathophysiological mechanisms are responsible for these changes.

Background: Despite advances in therapeutic management of patients with heart failure, there is still an increasing morbidity and mortality all over the world. In this study, we aimed to present the 3-year follow-up outcomes of patients included in the Journey HF-TR study in 2016 that has evaluated the clinical characteristics and management of patients with acute heart failure admitted to the hospital and present a national registry data.
Methods: The study was designed retrospectively between November 2016 and December 2019. Patient data included in the previously published Journey HF-TR study were used. Among 1606 patients, 1484 patients were included due to dropout of 122 patients due to inhospital death and due to exclusion of 173 due to incomplete data. The study included 1311 patients. Age, gender, concomitant chronic conditions, precipitating factors, New York Heart Association, and left ventricular ejection fraction factors were adjusted in the Cox regression analysis.
Results: During the 3-year follow-up period, the ratio of hospitalization and mortality was 70.5% and 52.1%, respectively. Common causes of mortality were acute decompensation of heart failure and acute coronary syndrome. Angiotensin receptor blockers, betablockers, statin, and sacubitril/valsartan were found to reduce mortality. Hospitalization due to acute decompensated heart failure, acute coronary syndrome, lung diseases, oncological diseases, and cerebrovascular diseases was associated with the increased risk of mortality. Implantation of cardiac devices also reduced the mortality.
Conclusions: Despite advances in therapeutic management of patients with heart failure, our study demonstrated that the long-term mortality still is high. Much more efforts are needed to improve the inhospital and long-term survival of patients with chronic heart failure.

Background: Fetal growth disturbance can be associated with cardiac dysfunction. This study aimed to assess the modified myocardial performance index in growth-restricted and appropriate for gestational age fetuses and evaluate both its prognostic value in perinatal period and also its association with adverse perinatal outcomes.
Methods: Totally 131 pregnant women were included in this prospective study. Of these, 56 cases were in study group with a diagnosis of small fetus and 75 cases were in control group with a diagnosis appropriately grown fetus. Fetal echocardiography was performed in all pregnant women to measure modified myocardial performance index. Umbilical, middle cerebral and uterine artery Doppler ultrasound parameters were measured in the study group. Small fetuses were categorized into 2 subgroups of late-onset fetal growth restriction and small for gestational age.
Results: Modified myocardial performance index was significantly higher in small fetuses compared to controls (0.45 vs. 0.37, P <.001). Newborn intensive care unit admission rates were significantly higher in small fetuses than in controls (chi-square test, P <.001). The
highest mean modified myocardial performance index was recorded in the late-onset fetal growth restriction subgroup (0.45 vs. 0.41 vs. 0.37). The sensitivity and specificity of modified myocardial performance index in predicting adverse outcomes at a cut-off value of 0.41 were 63% and 75%, respectively. There was a significant negative correlation between modified myocardial performance index values and birth weights.
Conclusions: We found higher left fetal heart modified myocardial performance index values in small fetuses indicating the presence of prenatal cardiac dysfunction. Fetal myocardial performance deteriorates in concordance with severity of growth restriction. Modified myocardial performance index can also be used to predict adverse perinatal outcomes among growth-restricted fetuses.

Objective: Malignant pericardial effusion may affect almost 15 of the patients with underlying malignancies which deteriorates the prognosis. The prognostic significance of pericardial fluid cytology is under-represented in previous studies.
Methods: A total of 73 patients with symptomatic pericardial effusion treated with pericardiocentesis were included in this retrospective analysis. Macroscopic appearance, biochemical features, and cytological findings were obtained. Patients were divided into 3 groups: (i) without malignancy, (ii) with malignancy and negative cytology, and (iii) with malignancy and positive cytology. Survival data were searched via governmental death notification system.
Results: Mean age of the study group was 62 ± 15, and 54% (40) of the patients were female. On the cytological evaluation, 17 patients (23.3%) revealed positive cancer cytology, whereas 56 patients (76.7%) revealed negative cancer cytology. The median follow-up period was 840 days, and 34 patients (46.5%) died during follow-up. The survival rate of Group 3 was found to be significantly worse compared to Groups 1 and 2, no statistical difference was found between Groups 1 and 2 in terms of survival ( Group 1 vs. Group 2 P =.078; Group 1 vs. Group 3 P <.001; Group 2 vs. Group 3 P =.041).
Conclusion: Cytological evaluation is an important step in patients with malignant pericardial effusion. Positive pericardial fluid cytology indicates a poorer prognosis.