Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves' Disease Before and After Anti-Thyroid Therapy.

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 (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 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).

Increased Rates of Coronary Artery Calcium Score in Patients with Non - Functioning Adrenal Incidentaloma.

AIM: We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal incidentalomas (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 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 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.

The relationship between visible thrombus aspiration material with no-reflow and in-hospital mortality ratio in patients with anterior ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

OBJECTIVE: The benefit of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is not yet fully clear. The aim of this study was to investigate the clinical impact of visible thrombus aspiration (VTA) material. METHODS: A total of 295 patients with a Thrombolysis in Myocardial Infarction (TIMI) flow score of 0 or 1 after an anterior STEMI were included in the study. Manual TA devices were used before performing PCI. The patients were divided into 2 groups: (1) visible thrombus aspiration (VTA) group and (2) non-visible thrombus aspiration (non-VTA) group. No-reflow was defined as TIMI grade 0, 1, or 2 flow, or TIMI grade 3 with a myocardial blush of grade 0 or 1. The primary endpoint was the occurrence of no-reflow. RESULTS: VTA was retrieved in 178 (60.3%) of the patients. A no-reflow determination was significantly less frequent in the VTA group (p<0.001). The ejection fraction and ST-segment resolution values were higher, and the in-hospital mortality, Killip class II-IV rating, and post-pPCI TIMI frame count were lower in the VTA group (p<0.05 for each). CONCLUSION: VTA predicted a lower rate of in-hospital mortality and no-reflow in patients with anterior STEMI who underwent pPCI.

Impact of 25(OH)D3 on spontaneous reperfusion and SYNTAX score in patients with ST-elevation myocardial infarction.

OBJECTIVE: The aim of this study was to evaluate the potential relationship between 25-hydroxyvitamin D3 (25[OH]D3), the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, and spontaneous reperfusion (SR) in patients with ST-elevation myocardial infarction (STEMI). METHODS: A total of 148 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention were retrospectively enrolled in the study. RESULTS: In all, 36 patients with a TIMI 3 flow score (spontaneous reperfusion [SR]) before coronary intervention constituted Group 1, and 112 patients with a TIMI flow score of 0-2 served as Group 2. The SYNTAX score and the in-hospital major adverse cardiovascular event (MACE) rate were significantly higher in Group 2 (p<0.001, p=0.012, respectively). The mean 25(OH)D3 level was significantly higher in Group 1 (p=0.003). Age, Killip class, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide were correlated with the SYNTAX score, and 25(OH)D3, troponin-I, C-reactive protein, and creatinine were weakly correlated with the SYNTAX score. Multilogistic regression analysis indicated that the SYNTAX score (p<0.001), Rentrop collateral (p=0.049), and troponin-I (p=0.004) were significantly effective at predicting SR, and 25(OH)D3 (p=0.079) and high-density lipoprotein (p=0.055) were borderline effective. CONCLUSION: A lower level of 25(OH)D3 may be associated with the absence of SR, increased disease severity, and inhospital MACE rates in patients with STEMI.

Thiol/disulphide homeostasis in thoracic aortic aneurysm and acute aortic syndrome.

AIM: The aim of this study was to evaluate whether ranging values of thiol and disulphide herald a dilatation or impending acute aortic syndrome at thoracic aorta. Results/methodology: Study population consisted of patients with aortic aneurysm (n = 58), with acute aortic syndrome (n = 32) and without aortic aneurysm (control group; n = 61). A spectrophotometric method was used to determine thiol and disulphide. Native and total thiol levels were moderately correlated with maximal aortic diameter. At the end of 6 months, there was statistically significant increase in native, total thiol levels and decrease in disulfide and disulphide/native thiol ratio in operated group. DISCUSSION/CONCLUSION: Lower thiol levels may be associated with the higher risk of aortic aneurysm development and may increase after surgical therapy.

The Role of Thiol/Disulphide Homeostasis in Anthracycline Associated Cardiac Toxicity.

The aim of the present study was to evaluate whether the baseline thiol/disulfide state can predict the occurrence of anthracycline induced cardiac toxicity. A total of 186 cancer patients receiving anthracycline (doxorubicin)-based chemotherapy were enrolled. All patients underwent 2-dimensional (2D) speckle tracking echocardiography (STE) to determine their left ventricular ejection fraction (LVEF) and blood samples for measuring thiol forms were obtained before treatment and 4 weeks after completion of the chemotherapy. The mean dose of doxorubicin exposure was 255 ± 39.2 mg/m2. Baseline native thiol was found to be lower whereas baseline disulfide and the disulfide/total thiol ratio were found to be higher in patients who had a decrease in LVEF after anthracycline therapy. Also, the amount of decrease in LVEF was well correlated with the delta value of the thiol forms. Logistic regression analysis revealed that changes in BNP and global longitudinal strain (GLS), baseline level of native thiol, disulfide, and the disulfide/total thiol ratio were strong predictors for a decrease in LVEF.The thiol/disulfide pathway may be a factor for predicting chemotherapy-induced cardiac toxicity as one of the oxidative stress mechanisms.