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Öğe Awareness of cardiac rehabilitation in people with cardiovascular diseases in Hatay: A cross-sectional study(2023) Huzmeli, Irem; Katayıfçı, Nihan; Akkus, OguzAim: This study aimed to assess the awareness of cardiac rehabilitation (CR) among patients with cardiovascular disease (CVD) in Hatay. Methods: In the study, 218 patients (44.5% male, 55.5% female) in an age range of 18 to 84 [median 57(46.75–65.25) years] with CVD completed an awareness questionnaire, which included 35 items that addressed knowledge about CVD, CR features and content, CR effectiveness, reasons for not participating in CR programs, and general knowledge about CR. Results: Ninety-seven (44.5%) participants stated that they had knowledge about CVD, and 29.5% thought CR was required to prevent heart diseases. Fifty-nine subjects expressed they knew the exercises they needed to practice for CVD. Participants mostly accepted that CR effectively regulated blood lipids and blood pressure and managed blood glucose, obesity, and general well-being. One hundred patients (45.7%) reported that they did not participate in a CR program because they had no knowledge of CR. Most participants (60.6%) were undecided about whether the CR program was available in their city and whether it would be beneficial in treating heart diseases (50.5%). Men, young people, and people with higher education levels were more aware of the components of CR (p<0.05). Conclusion: There was a lack of awareness regarding the content of CR, especially in exercise and protective factors for CVDs in Hatay. Seminars are needed to increase the awareness of CR in the community. Health professionals should encourage patients with cardiovascular disease to support the outreach of the CR program.Öğe Basal Septal Hypertrophy as the Early Imaging Biomarker for Adaptive Phase of Remodeling Prior to Heart Failure(Mdpi, 2022) Yalcin, Fatih; Yalcin, Hulya; Kucukler, Nagehan; Arslan, Serbay; Akkus, Oguz; Kurtul, Alparslan; Abraham, Maria RoselleHypertension plays a dominant role in the development of left ventricular (LV) remodeling and heart failure, in addition to being the main risk factor for coronary artery disease. In this review, we focus on the focal geometric and functional tissue aspects of the LV septal base, since basal septal hypertrophy (BSH), as the early imaging biomarker of LV remodeling due to hypertensive heart disease, is detected in cross-sectional clinic studies. In addition, the validation of BSH by animal studies using third generation microimaging and relevant clinical observations are also discussed in the report. Finally, an evaluation of both human and animal quantitative imaging studies and the importance of combined cardiac imaging methods and stress-induction in the separation of adaptive and maladaptive phases of the LV remodeling are pointed out. As a result, BSH, as the early imaging biomarker and quantitative follow-up of functional analysis in hypertension, could possibly contribute to early treatment in a timely fashion in the prevention of hypertensive disease progression to heart failure. A variety of stress stimuli in etiopathogenesis and the difficulty of diagnosing pure hemodynamic overload mediated BSH lead to an absence of the certain prevalence of this particular finding in the population.Öğe Changes in Acute Coronary Syndrome Clinic after the Devastating Earthquake in Türkiye(Kare Publ, 2024) Akkus, Oguz; Yasdiba, Ramazan; Demirkiran, Ramazan Furkan; Elitas, Veysel; Bekler, Ozkan; Sen, Fatih; Binokay, HulyaBackground: We aimed to investigate the clinical and angiographic characteristics of patients with acute coronary syndrome (ACS) who survived this devastating earthquake and were admitted to our hospital in Antakya/T & uuml;rkiye. Methods: We retrospectively examined the impact of the earthquake on the occurrences of acute coronary syndromes in Antakya/T & uuml;rkiye. All 248 consecutive patients with ACS, also survivors of the earthquake in Antakya, were enrolled as the earthquake group. The earthquake group was created from patients hospitalized between February and June in 2023 after the earthquake. In total, 209 consecutive ACS patients who were hospitalized in our cardiology clinic in similar months of 2022 named as the control group. Results: Patients admitted before the earthquake were more hospitalized with multi- vessel disease compared to after the earthquake group (P < .001). Myocardial infarction with non-obstructive coronary artery disease (MINOCA) was the main reason for the significant increase rate of ACS after the earthquake. The earthquake patient group had lesser diabetes mellitus than the control group (P < .001). The risk of men suffering from ACS after an earthquake is approximately 2.1 times higher than women (P = .023). Those with a history of revascularization are approximately 1.8 times more likely to have ACS after an earthquake (P = .05). The risk of experiencing ACS after an earthquake is approximately 3.5 times higher for those with a family history than for those without (P < .001). Conclusion: Effects of the devastating earthquake on the heart are the increase in MINOCA patients triggered by great sudden environmental stress and the decrease in diabetes due to worsening nutritional conditions, respectively.Öğe 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, OguzBackground: 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).Öğe Comparison of functional exercise capacity, quality of life and respiratory and peripheral muscle strength between patients with stable angina and healthy controls(Sage Publications Ltd, 2020) Huzmeli, Irem; Ozer, Aysel-Yildiz; Akkus, Oguz; Katayifci, Nihan; Sen, Fatih; Yurdalan, Saadet Ufuk; Polat, Mine GuldenObjective We aimed to compare functional exercise capacity, respiratory and peripheral muscle strength, pulmonary function and quality of life between patients with stable angina and healthy controls. Methods We compared 33 patients with stable angina (55.21 +/- 6.12 years old, Canada Class II-III, left ventricular ejection fraction: 61.92 +/- 7.55) and 30 healthy controls (52.70 +/- 4.22 years old). Functional capacity (6-minute walk test (6-MWT)), respiratory muscle strength (mouth pressure device), peripheral muscle strength (dynamometer), pulmonary function (spirometer) and quality of life (Short Form 36 (SF-36)) were evaluated. Results 6-MWT distance (499.20 +/- 51.91 m versus 633.05 +/- 57.62 m), maximal inspiratory pressure (85.42 +/- 20.52 cmH(2)O versus 110.44 +/- 32.95 cmH(2)O), maximal expiratory pressure (83.33 +/- 19.05 cmH(2)O versus 147.96 +/- 54.80 cmH(2)O) and peripheral muscle strength, pulmonary function and SF-36 sub-scores were lower in the angina group versus the healthy controls, respectively. Conclusion Impaired peripheral and respiratory muscle strength, reduction in exercise capacity and quality of life are obvious in patients with stable angina. Therefore, these parameters should be considered in stable angina physiotherapy programmes to improve impairments.Öğe 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, EmelPurpose: 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.Öğe Effectiveness of Device-Guided Breathing in Chronic Coronary Syndrome: A Randomized Controlled Study(Taiwan Soc Cardiology, 2023) Akkus, Oguz; Huzmeli, Irem; Seker, Taner; Bekler, Ozkan; Sen, Fatih; Kaypakli, Onur; Ozer, Aysel YildizBackground: Chronic coronary syndrome (CCS) is one of the most life-restricting coronary artery diseases, and symptom relief is the main goal in CCS patients who suffer from angina.Objectives: To assess the potential benefits of device-guided breathing in CCS patients with angina in this randomized, controlled, single-blinded study.Methods: Fifty-one patients with CCS received device-guided breathing for 7 days/8 weeks. Exercise capacity [exercise stress test], cardiac function [transthoracic echocardiography], and angina severity [Canadian Cardiovascular Society Classification] were evaluated initially and after the training. Device-guided breathing was performed at the lowest resistance of the device (POWERbreathe (R) Classic LR) for the control group (n = 17). The low load training group (LLTG; n = 18) and high load training group (HLTG; n = 16) were trained at 30% and 50% of maximal inspiratory pressure. Baseline characteristics were compared using one-way ANOVA and Kruskal-Wallis test. Categorical data were compared using the chi-square test. ANCOVA was performed to compare changes between three groups. A p value < 0.05 was considered statistically significant.Results: Metabolic equivalent values were significantly improved in both HLTG and LLTG groups (p < 0.001, p = 0.003). The Duke treadmill score significantly improved and shifted to low-risk both in the HLTG (p < 0.001) and LLTG (p < 0.001) groups. Angina severity significantly alleviated after the training in both HLTG and LLTG groups (p < 0.001, p = 0.002).Conclusions: An 8-week long program of short-term respiratory muscle training provided positive gains in exercise capacity and angina severity in CCS patients with angina. The effects of long-term training programs on CCS patients should be investigated clinically because of the possibility of helping to decrease the need for invasive treatments.Öğe 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, MehmetPurpose: 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.Öğe 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, FatihAim: 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.Öğe 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, GamzeBackground: 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.Öğe 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, OnurBackground: 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.Öğe The relationship between low thiol levels and major adverse cardiovascular events after primary percutaneous coronary intervention in patients with STEMI(Turkish Soc Cardiology, 2018) Akkus, Oguz; Topuz, Mustafa; Koca, Hasan; Harbalioglu, Hazar; Kaypakli, Onur; Kaplan, Mehmet; Sen, OmerOjective: The aim of this study was to investigate whether low thiol levels are associated with peri-procedural factors during primary percutaneous coronary intervention (pPCI) upon admission with ST-segment elevation myocardial infarction (STEMI), and the prognostic value at 6-month follow-up. Methods: A total of 241 consecutive acute STEMI patients who underwent pPCI and a control group of 67 individuals with a normal coronary angiography were enrolled in the study. Result: While age, contrast-induced nephropathy, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), stent length, and creatinine were related to native thiol, NT-proBNP, contrast-induced nephropathy, and creatinine were related to total thiol. NT-proBNP was also related to the disulphide level. The left ventricular ejection fraction (LVEF) and the levels of native thiol, total thiol, low-density lipoprotein, and serum albumin were found to be independent predictors of major adverse cardiovascular events (MACEs) during 6 months of follow-up. Conclusion: Initial lower native thiol, total thiol, LVEF, LDL, and serum albumin may be used to identify patients with an increased long-term risk of unfavorable cardiac events in case of STEMI.
