Since severe acute respiratory syndrome coronavirus 2 led to a world pandemic, extensive research has been conducted to identify its characteristics and form an appropriate management plan. One recognized complication of COVID-19 is coagulation defects that can lead to thromboembolic events.

We have reviewed the literature to summarize and present the latest research about the pathophysiology, clinical manifestations, anticoagulation use and appropriate dose in COVID-19 patients, as well as the effect of anticoagulation in outpatient and post-hospital settings. The pathophysiology of coagulation abnormalities in COVID-19 is not fully understood yet, but multiple mechanisms appear to be involved, such as a direct viral attack, hyperinflammation, increased immune response, blood stasis, and endothelial injury. Clinical manifestations are mainly venous thromboembolism (deep vein thrombosis and pulmonary embolism), arterial thromboembolism, ischemic stroke, central venous sinus thrombosis, and central retinal vein occlusion. Anticoagulation is widely used in hospitalized patients with COVID-19, unless it is contraindicated. Heparinoid is the main anticoagulant used. However, the appropriate dosage is still debated as research is trying to find a balance between benefits and risks. In outpatients, it appears that anticoagulation has no benefit in contrast to post-hospitalization use, where benefit could be observed in severely affected patients.

We concluded that thromboprophylaxis should be used in treating hospitalized COVID-19 patients, but the dosage is still a matter of debate. More research needs to be done on outpatient and post-hospitalized patients to derive accurate conclusions.

Background: Several studies have shown that malnutrition helps to predict the occurrence of adverse outcomes after transcatheter aortic valve replacement. However, there is still controversy and uncertainty regarding the prevalence and consequences of malnutrition. We performed a systematic review and meta-analysis to assess the relationship between malnutrition and poor postoperative outcomes in transcatheter aortic valve replacement.

Methods: Observational studies were searched in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE regarding the relationship between malnutrition and adverse outcomes after transcatheter aortic valve replacement, with the primary end-point being all-cause mortality and secondary outcomes such as cardiovascular complications and readmission rates. This meta-analysis was registered in PROSPERO (number CRD42022310139).

Results: A total of 10 studies involving 5936 subjects were included in the systematic review and meta-analysis. The results showed that malnourished patients had an increased risk of all-cause mortality after transcatheter aortic valve replacement compared with non-malnourished patients (hazard ratios [HR] = 1.32, 95% CI [1.13, 1.53], P <.01). Subgroup analysis showed that in Asia, postoperative all-cause mortality was significantly higher in malnourished transcatheter aortic valve replacement patients than in non-malnourished transcatheter aortic valve replacement patients (P <.01), and in addition, sample size and follow-up time may have contributed to the large heterogeneity.

Conclusion: Malnutrition increases the risk of all-cause mortality in such patients and may predict the occurrence of adverse postoperative outcomes.

Background: No evidence exists on the impact of bivalirudin in patients with the acute coronary syndrome undergoing rotational atherectomy. This study aimed to evaluate the impact of bivalirudin on patients with acute coronary syndrome undergoing rotational atherectomy.

Methods: This was a retrospective cohort study conducted in our hospital between January 2017 and December 2019. The study included patients with acute coronary syndrome undergoing rotational atherectomy. Furthermore, 2 cohorts were included in this study (bivalirudin cohort and control cohort unfractionated heparin). The primary end-point was in-hospital net adverse clinical events. The secondary endpoint was all-cause mortality at 23 months.

Results: The study included 157 patients with 33 (21.0%) in the bivalirudin cohort and 124 (79.0%) in the control cohort. Net adverse clinical events during hospitalization in the bivalirudin cohort were higher than that in the control cohort [9 (27.3%) vs. 14 (11.3%), P = .021]. However, there was no significant difference in all-cause mortality at 23 months between the 2 cohorts [25 (20.2%) vs. 10 (30.3%), P =.214]. After adjusting for potential confounders, the usage of bivalirudin was not associated with net adverse clinical event (odds ratio = 0.90; 95% CI: 0.18-4.45; P =.890), and the hazard ratio for all-cause mortality at 23 months was 1.01 (95% CI: 0.33-3.15; P =.983).

Conclusion: Bivalirudin appears to exhibit a similar impact as unfractionated heparin on patients with acute coronary syndrome undergoing rotational atherectomy in real-life setting.

Background: Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey.

Methods: The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT05296694).

In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort.

Results: The short-term outcomes of the study are planned to be shared by early 2023.

Conclusion: The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units.

Background: Although a wide spectrum of resistance exercise intensities was recommended in the guidelines, none of them investigated the acute effects of different intensities of the resistance exercise on cardiac autonomic function in patients with chronic heart failure. This study aimed to investigate the acute effects of the low and high intensities of the resistance exercise on heart rate variability in chronic heart failure.

Methods: This randomized controlled trial was performed between October 2019 and December 2020. Fifty-seven patients with chronic heart failure (New York Heart Association class II and class III) underwent hemodynamic, functional capacity, and heart rate variability (time and frequency domains) assessments. They were randomly divided into R1, R2, and control groups. The intervention consisted of performing a short aerobic exercise including 15 minutes of walking at an intensity of 50% reserved heart rate for all 3 groups and additional resistance exercise with the intensity of 50% 1-repetition maximum and 75% 1-repetition maximum for R1 and R2 groups, respectively.

Results: The standard deviation of normal to normal intervals and standard deviation of average NN intervals became significantly lower in R2 (P =.031), and both high-frequency power and low-frequency power were significantly higher in R1 (P =.039 and P =.004, respectively) after the intervention. No significant changes were observed in the control group. Between-group changes were not significant for hemodynamics and functional capacity after treatment. The between-group comparison demonstrated a significant increase in root mean square of successive differences of the NN intervals in R1 in comparison to the control (P =.035).

Conclusions: These findings indicate that resistance exercise in 50% 1-repetition maximum in comparison to 75% 1-repetition maximum had more favorable effects on the heart rate variability in chronic heart failure.

Background: This study aimed to identify the biomarkers related to myocardial infarction based on building lncRNA–miRNA–mRNA ceRNA regulation network.

Methods: The expression profile data were obtained from the Gene Expression Omnibus database. The differentially expressed RNAs (DElncRNAs, DEmiRNAs, and DEmRNAs) were analyzed using the limma package of R. In addition, the differential myocardial infarction-related genes were obtained and the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway on the differential myocardial infarction-related genes were analyzed. The co-expression network of lncRNA–mRNA was constructed, and the Kyoto Encyclopedia of Genes and Genomes pathway of such a co-expression network was analyzed. Moreover, the lncRNA–miRNA–mRNA ceRNA network associated with myocardial infarction was built, and the key biomarkers of the ceRNA network were verified using the GSE141512 and GSE66752 datasets.

Results: In total, we acquired 51 DElncRNAs, 276 DEmiRNAs, and 1200 DEmRNAs as well as 291 differential myocardial infarction-related genes. Moreover, the co-expression network of lncRNA–mRNA was built, and mRNAs were found to be associated with 109 Kyoto Encyclopedia of Genes and Genomes pathways (the target gene of RP3-394A18.1 was significantly related to lipid and atherosclerosis). In addition, the ceRNA network related to myocardial infarction was constructed, and the dataset analyses of the RNAs were validated between the myocardial infarction and normal groups. It was also found that the expression levels of hsa-miR-1291 and Retinoid acid receptor-related orphan
receptor α (RORA) in the myocardial infarction group were noticeably lower than those in the normal group, whereas the expression levels of ENTPD1, QSOX1, and TIMP2 in the myocardial infarction group were noticeably higher than those in the normal group.

Conclusion: In this study, we built a ceRNA regulation network of myocardial infarction. This study could help identify the biomarkers related to myocardial infarction.

Background: Pulmonary embolism severity index, its simplified version, and shock index have been used for risk stratification in acute pulmonary embolism. In this study, we proposed a modification in severity index and evaluated the correlates and prognostic value of modification in severity index in this setting.

Methods: The study group comprised retrospectively evaluated 181 patients with acute pulmonary embolism. Systematic workup including pulmonary embolism severity index, its simplified version, shock index, biomarkers, and echocardiographic and multidetector computed tomography assessments was performed in all patients. Moreover, we calculated modification in severity index by multiplying original shock index (heart rate/systolic blood pressure ratio) and a third component, 1/pulse oxymetric saturation (pSat O2%) ratio. The primary endpoint was defined as all-cause mortality and hemodynamic collapse during the hospital stay.

Results: On the basis of initial risk stratification, ultrasound-assisted thrombolysis, systemic tissue-type plasminogen activator, and unfractionated heparin therapies were utilized in 83 (45.9%), 37 (20.4%), and 61 (33.7%) patients, respectively. The primary end-point occurred in 13 (7.2%) patients. Receiver-operating curve analysis revealed that modification in severity index had the highest area under the curve of 0.739 (0.588-0.890, P =.002) compared with shock index, pulmonary embolism severity index, or its simplified version. The modification in severity index > 0.989 predicted primary endpoint with 73% sensitivity and 54% specificity.

Conclusions: The modification in severity index seems to be a simple, quick, and compre-hensive risk assessment tool for bedside evaluation at initial stratification, in monitoring the clinical benefit from therapies, and decision-making for escalation to other reperfusion strategies in patients with acute pulmonary embolism. However, the prognostic value of modification in severity index needs to be validated with further studies.