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    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, Hulya
    Background: 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.
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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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    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 Yildiz
    Background: 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.
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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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    Pan-Immune-Inflammation Value Is Independently Correlated to Impaired Coronary Flow After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction
    (Excerpta Medica Inc-Elsevier Science Inc, 2024) Sen, Fatih; Kurtul, Alparslan; Bekler, Ozkan
    Immune-inflammatory biomarkers have been shown to be correlated with impaired coronary flow (ICF) in ST-segment elevation myocardial infarction. In this study, we assessed the relation between a novel comprehensive biomarker, pan-immune-inflammation value (PIV), and ICF after primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction. A total of 687 patients who underwent pPCI between 2019 and 2023 were retrospectively analyzed. Blood samples were collected at admission. PIV and other inflammation parameters were compared. PIV was calculated as (neutrophil count x platelet count x monocyte count)/lymphocyte count. Postprocedural coronary flow was assessed by thrombolysis in myocardial infarction (TIMI) classification. Patients were divided into 2 groups: a group with ICF defined as postprocedural TIMI 0 to 2 and a group with normal coronary flow defined as postprocedural TIMI flow grade of 3. The mean age was 61 +/- 12 years, and 22.4% of the patients were women. Compared with the normal coronary flow group (median 492, interquartile range 275 to 931), the ICF group (median 1,540, interquartile range 834 to 2,909) showed significantly increased PIV (p <0.001). The optimal cutoff for the PIV was 804, as determined by receiver operating characteristic curve. The incidence of ICF was 17.0% in all patients, 6.4% in low-PIV group (<804), and 34.2% in high-PIV group (>= 804). Multivariate analyses revealed that a baseline PIV >= 804 was independently associated with post-pPCI ICF (odds ratio 5.226, p <0.001). PIV was superior to neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in determining ICF. In conclusion, a high-PIV was significantly associated with an increased risk of ICF after pPCI. More-over, PIV was a better indicator of ICF than were other inflammatory markers.(c) 2023 Elsevier Inc. All rights reserved.