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    Ability of CHA2DS2-VASc/R2CHA2DS2-VASc Scores to Predict Complications Related to Cardiac Implantable Electronic Devices
    (John Wiley and Sons Inc, 2025) Söner, Serdar; Aktan, Adem; Kılıç, Raif; Güzel, Hamdullah; Taştan, Ercan; Okşul, Metin; Cömert, Adnan Duha
    Background: Globally, the number of cardiac implantable electronic devices (CIEDs) is increasing. In our study, we aimed to investigate whether CHA2DS2-VASc and R2CHA2DS2-VASc scores are predictive of CIED-related complications. Methods: Our investigation was carried out with a multicenter retrospective design. Patients who underwent CIED surgery at two cardiac centers in Turkey between January 2011 and May 2023, 1676, were evaluated. The patients were divided into two groups according to their R2CHA2DS2-VASc scores. Patients with R2CHA2DS2-VASc ≥ 5 were included in group 1 (380 patients), and patients with R2CHA2DS2-VASc < 5 (1296 patients) were included in group 2. The primary outcome was defined as the cumulative events. Each component of cumulative events, such as hematoma, pericardial effusion, pneumothorax, and infection, was also defined as a secondary outcome. Results: The study's patient population had an average age of 62.9 ± 14 years. Pneumothorax (1.8% vs. 1.3%, p = 0.444), pericardial effusion or tamponade (0.35% vs. 0.2%, p = 0.659), and clinically significant hematoma (1.1% vs. 0.6%, p = 0.376) were comparable between the groups. Infection-related devices and cumulative events classified as primary outcomes were higher in the R2CHA2DS2-VASc ≥ 5 group (6.1% vs. 1.2%, p < 0.001; 7.6% vs. 3.2%, p < 0.001, respectively). Modeling analyses showed that the CHA2DS2-VASc score and HT were also independent predictors of device-related infection and cumulative events. Conclusion: In the R2CHA2DS2-VASc ≥ 5 groups, infection related to the device system and cumulative events were higher. Patients with an R2CHA2DS2-VASc score of 5 or more and a high CHA2DS2-VASc score should be evaluated more carefully regarding infection and cumulative events before and after the operation. © 2025 Wiley Periodicals LLC.
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    Predictive value of nutritional scores in non-valvular atrial fibrillation patients: Insights from the AFTER-2 study
    (Elsevier B.V., 2025) Söner, Serdar; Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Arslan, Bayram; Demir, Muhammed; Güzel, Hamdullah
    Background and aim: Many scoring systems are used to evaluate malnutrition, but there is no consensus on which scoring system would be more appropriate. We aimed to investigate the effect of malnutrition in patients with non-valvular atrial fibrillation (NVAF) and to compare three scoring systems. Methods and results: A total of 2592 patients with non-valvular AF from 35 different centers in Turkey were included in this prospective study. All participants were divided into two groups: 761 patients who died and 1831 patients who were alive. The malnutrition status of all participants was evaluated with three scoring systems. The primary outcome was all-cause mortality. The mean age of the population was 68.7 ± 11.1 years, and 55.5 % were female. According to Cox regression analysis, the geriatric nutritional risk index (GNRI) (HR = 0.989, 95 % CI: 0.982–0.997, p = 0.007), controlling nutritional status (CONUT) score (HR = 1.121, 95 % CI: 1.060–1.185, p < 0.001), and prognostic nutritional index (PNI) (HR = 0.980, 95 % CI: 0.962–0.999, p = 0.036) were found to be significant mortality predictors. ROC curve analysis indicated GNRI (AUC = 0.568), CONUT (AUC = 0.572), and PNI (AUC = 0.547) had moderate predictive values. Kaplan-Meier analysis showed that increasing the risk class based on GNRI (p < 0.001) and CONUT (p < 0.001) was associated with decreased survival, while PNI staging had no statistically significant effect (p = 0.266). Conclusions: Malnutrition, determined by three scoring systems, was found to be an independent predictor of all-cause mortality in NVAF patients. Nutritional examination may provide useful information for prognosis and risk stratification in patients with NVAF. © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University