Aim: We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal incidentalomas (NFAIs) via the coronary-artery-calcium (CAC) score. Materials and Method: The participants were patients with an NFAI (n = 55). They were compared to patients with chest pain, a low-intermediate Framingham-risk score and a non-diagnostic treadmill-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, potassium, 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 fraction (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 an NFAI, at ≥100 Agatston units. Discussion: Patients with a low-intermediate CV risk profile and an NFAI have a higher risk of atherosclerosis, when compared to patients with a low-intermediate CV risk profile, but no NFAI. Conclusion: In cases where an NFAI exists, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.
Background: We aimed prospectively investigate the laboratory and electrocardiographic parameters (hearth rate, QRS, QT, QTc, Tpe, Tpe/QTc, arrhythmia prevalance) in patients with graves disease before and after antithyroid therapy. Methods: 71 patients (48 female, 23 male), age between 18-50 (mean±SD: 36.48±12.20 ) with GD were included into the study. Patients treated with antithyroid therapy (thionamids 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 (fT4) and tri-iodothyrionine (fT3) 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 of 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 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 baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients became their euthyroid status, group 2 patients had still suffered from more sustained supraventricular ectopics beats than group 1. Conclusion: Distinct from medical treatment group, surgical treatment group with euthyroidism at least 3 months had still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).
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.Amaç: Bu çalışma ile COVID-19 hastalarında 12derivasyonlu elektrokardiyografinin (EKG) standart değerlendirmesine ek olarak yeni aritmi belirteçlerini ve tedavi etkisininin araştırılması amaçlanmıştır. Gereç ve Yöntem: Toplam 51 COVID-19 hastasının 12derivasyonlu EKG si tedavi öncesi, tedavinin 2. ve 5. günlerinde geriye dönük olarak değerlendirildi. Hastalar COVID-19'a yönelik hidroksiklorokin (HCQ) + azitromisin veya sadece HCQ tedavisi aldı. Ciddi COVID-19 hastaları, pnömoni bulgularına ek olarak SpO2<90% veya solunum sayısı >30/dk olarak tanımlandı. Bulgular: Hastaların %68,6'ı HCQ + azitromisin kombinasyon tedavisi alırken, %31,4 hasta sadece azitromisin tedavisi aldı. Tedavinin 2. gününde, kombinasyon tedavisi alanlarda ve sadece azitromisin alanlarda sadece kalp hızı istatistiksel olarak anlamlı değişken olarak bulundu. Tedavinin 5. gününde kalp hızına ek olarak ve cTpe değerleri her iki tedavi rejiminde istatistiksel olarak anlamlı olarak bulundu. Tedavi süresince her iki tedavi rejiminde Tpe düzeyleri istatistiksel anlamlı olarak artmasına rağmen, rölatif artış oranları istatistiksel olarak gruplar arası benzer bulundu. Sonuç: Çalışma sonuçlarımız, kısa süreli hastanede yatan COVID-19 hastalarında kullandığımız HCQ/ azitromisin tedavisinin kabul edilebilir düzeyde kardiyak etki profiline sahip olduğunu göstermektedir.
Aim: We aimed to detect the predictive value of CS distal delay interval for differentiating the left from right sided PVCs. Methods: We included 137 patients with symptomatic frequent premature ventricular contractions (PVCs) who underwent successful catheter ablation retrospectively (67 male, 70 female; mean age 46.0 ± 16.2 years). Patients were classified into two groups as left sided and right sided PVCs. Decapolar catheters were placed in the coronary sinus before the procedure. CS distal delay interval (Q-CSd) was measured as the interval from onset of earliest QRS complex of premature ventricular contractions in 12 lead ECG to distal CS EGM signal. Results: CS distal delay interval was found to be significantly lower in left sided PVCs. The cutoff value of CS distal delay interval obtained by ROC curve analysis was 48,5 ms for prediction of right sided origin (sensitivity: 91,5%, specificity: 85.9%). The area under the curve (AUC) was 0.911 (p<0.001). Conclusion: CS distal delay interval is a novel and simple measurement for accurately differentiating the left from right sided PVCs. The use of this simple measurement could be beneficial for decreasing ablation duration, radiation exposure and the number of arterial or venous punctures.
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