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    Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves' Disease Before and After Anti-Thyroid Therapy
    (Bentham Science Publ Ltd, 2021) Akkus, Gamze; Sokmen, Yeliz; Yilmaz, Mehmet; Bekler, Ozkan; Akkus, Oguz
    Background: We aimed prospectively to investigate the laboratory and electrocardiographic parameters (heart rate, QRS, QT, QTc, Tpe, Tpe/QTc, and arrhythmia prevalence) in patients with Graves' disease before and after antithyroid therapy. Methods: Seventy-one patients (48 female, and 23 male), of age between 18-50 years (mean +/- SD: 36.48 +/- 12.20) with GD were included in the study. Patients were treated with antithyroid therapy (thioamides and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment. Results: Mean TSH, free thyroxin (fT(4)), and tri-iodothyrionine (fT(3)) levels of all patients were 0.005 +/- 0.21, 3.27 +/- 1.81, 11.42 +/- 7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious malignant nodule or large goiter, and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to a medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise, the baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients came at their euthyroid status, group 2 patients still suffered from more sustained supraventricular ectopics beats than group 1. Conclusion: Distinct from the medical treatment group, surgical treatment group with euthyroidism for at least 3 months still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).
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    The correlation study of cardiovascular functions and iron overload by echocardiographic indices in thalessemia patients
    (Cukurova Univ, Fac Medicine, 2020) Akkus, Gamze; Akkus, Oguz; Nas, Kamil; Acarturk, Esmeray; Gurkan, Emel
    Purpose: The aim of this study was to evaluate arterial stiffness with echocardiographic and oscillometric (TensioMed arteriography) methods in thalassemia patients. Materials and Methods: We enrolled 44 participants from both gender (24 thalasemia patients, 20 control patients). Hematologic and hemodynamic parameters were recorded. Arterial stiffness was assessed non-invasively by measurement of pulse wave velocity, augmentation index, aortic strain, distensibility and arterial stiffness index by using TensioMed arteriography and echocardiography. Results: Aortic strain and arterial stiffness index were found to be significant between two groups. Pulse wave velocity had borderline significance between thalasemia and control patients. Tissue doppler early (E ') and late (A') mitral annular diastolic filling velocities in patients with beta thalassemia were significantly lower than the control group. Conclusion: Tissue doppler echocardiographic evaluation was useful in determining the development of diastolic dysfunction in patients with thalassemia. Arterial stiffness indices, especially aortic strain, arterial stiffness index and pulse wave velocity are a useful and easy methods to predict risk of vascular aging at thalassemia patients.
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    Electrocardiographic findings and cardiac safety of hydroxychloroquine+azithromycin in hospitalized patients with COVID-19
    (Cukurova Univ, Fac Medicine, 2021) Akkus, Oguz; Bal, Tayibe; Yagoobi, Hasibullah; Bekler, Ozkan; Akkus, Gamze; Cabalak, Mehmet
    Purpose: The aim of this study was to determine the novel arrhythmia markers (Tpe, cTpe, cTpe/cQT) in addition to standard evaluation of 12-derived electrocardiography (ECG) and effects of therapy in patients with COVID-19. Materials and Methods: We evaluated 12-derived ECG in 51 patients with COVID-19 at the pre-treatment stage and on the 2nd and 5th days of the treatment, retrospectively. Patients were treated by either hydroxychloroquine (HCQ) + azithromycin or HCQ alone. Severe COVID-19 patients were defined with the presence of clinical signs and symptoms of pneumonia plus SpO2<90%, or respiratory rate > 30 breathe/minute. Results: While 68.6% of patients received HCQ + azithromycin combination therapy, 31.4% of patients received HCQ monotherapy. On the 2nd day of the treatment, heart rate was the only statistically significant variable either on the treatment of HCQ + azithromycin or HCQ alone. On the 5th day of treatment, in addition to the heart rate, Tpe and cTpe levels were also statistically significant among the whole treatment regimens. Although Tpe statistically significantly increased in both treatment strategies during treatment, increasing relative Tpe ratios were similar between both of the treatment strategies. Conclusion: The results of our study suggests that those off-label drugs (HCQ/azithromycin) have an acceptable cardiac safety profile in COVID-19 disease during short hospitalization.
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    Increased Rates of Coronary Artery Calcium Score in Patients with Non- Functioning Adrenal Incidentaloma
    (Bentham Science Publ Ltd, 2021) Akkus, Oguz; Akkus, Gamze; Kaypakli, Onur; Ozturk, Fatma Keles; Gurkan, Eren; Bekler, Ozkan; Sen, Fatih
    Aim: We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal in-cidentalomas (NFAIs) via the coronary-artery-calcium (CAC) score. Materials and Methods: The participants were patients with NFAI (n = 55). They were compared to patients with chest pain, a low-intermediate Framingham-risk score, and a non-diagnostic tread-mill-exercise test, which served as the control group (n = 49). Subsequently, the NFAI group was subdivided according to a CAC score of <100 Agatston units - mild coronary-artery calcification (n = 40) - and >100 Agatston units - moderate-to-severe calcification (n = 15). Results: Similar rates of traditional risk factors were observed between the NFAI and control groups, and lower low-density lipoprotein cholesterol rates were observed in the NFAI group. The CAC score was significantly higher for the NFAI group than the control group. Glucose, potassi-um, adrenocorticotropic-hormone, and basal-cortisol levels were higher in those with a CAC score of >100. High-density-lipoprotein cholesterol estimated glomerular filtration rate and ejection frac-tion (EF) were higher in those with a CAC score of <100. Adenoma size and location were similar between the groups. Age, EF, and glucose were the most significant variables related to CAC score in patients with NFAI, at >100 Agatston units. Discussion: Patients with a low-intermediate CV risk profile and NFAI have a higher risk of atherosclerosis when compared to patients with a low-intermediate CV risk profile, but no NFAI. Conclusion: In patients with NFAI, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.
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    Is Low-free Triiodothyronine (fT3) Associated with Increased Morbidity in Patients Admitted to Coronary Care Units?
    (Bentham Science Publ Ltd, 2024) Akkus, Oguz; Sen, Fatih; Yasdibas, Ramazan; Otegen, Alper Tunga; Huzmeli, Irem; Akkus, Gamze
    Background: The effects of thyroid hormone on patients hospitalized in coronary intensive care units are still controversial. Objective: We retrospectively examined thyroid hormone levels and their impact on cardiovascular morbidity in patients admitted to coronary intensive care units. Methods: A total of 208 (Female/Male; 46.6%/53.4%) patients without any history of thyroid disease were enrolled and screened. Patients with specific heart disease and existing thyroid hormone parameters were included in the study. Low triiodothyronine syndrome is characterized by reduced serum total or free T3 (fT3) concentrations in normal free T4 (fT4) and TSH levels. Results: The common diagnosis of the patients in the coronary care unit is acute coronary syndrome (n=59, 28.2%) and heart failure (n=46, 23.3%). Patients were divided into two groups according to left ventricular ejection fraction percentages (LVEF <= 39% vs LVEF >= 40%). Plasma fT3 levels were significantly correlated with low LVEF (<= 39%) (p =0.002). fT3 (r=-0.183, p =0.013) and hospitalization etiology (r=-0.161, p =0.023) were also the most critical parameters affecting the length of hospitalization. Conclusion: Low fT3 was associated with reduced ejection fraction and prolonged hospitalization, which may lead to potential morbidities in HF patients which may be useful in risk stratification and treatment strategies.
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    The Possible Effects of Dapagliflozin on 12-derived Electrocardiogram in Patients with Type 2 Diabetes Mellitus
    (Bentham Science Publ Ltd, 2019) Akkus, Oguz; Akkus, Gamze; Kaypakli, Onur
    Background: Dapagliflozin, sodium glucose cotransporter 2 inhibitor, has potential side effects on electrolyte imbalance as it has diuretic effects which include decreasing glucose reabsorption, increasing glucosuria and natriuresis. We aimed to determine the possible effects of dapagliflozin on electrocardiogram (ECG) in patients with type 2 DM. Material and Methods: This retrospective study consisted of 49 patients (25 female, 24 male). Patients who had inadequate glycemic control besides using several oral antidiabetics, subsequently endorsed with dapagliflozin, were included in the current study. Results: Meantime interval from treatment initiation to control was 10.5 +/- 5.03 weeks. Body mass index, glucose, HbAlC, eGFR, LDL-C, heart rate, systolic and diastolic blood pressures were found to be significantly lower at control admission (p<0.05). Creatinine and QT interval were significantly higher at control admission (p<0.05). Baseline Tpe duration and baseline Tpe/QT ratio were found to be significantly correlated with Tpe/QT difference (p<0.05). In linear regression analysis, baseline Tpe/QT ratio was found to be the sole independent predictor of Tpe/QT difference (p<0.05). Conclusion: Initiation of dapagliflozin treatment seems to be safe, up to several months, in terms of serum electrolytes and ECG findings in patients with type 2 DM with a probable improvement.