Browsing by Author "Kalejs, Oskars"
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Item Assessment of Cardiac Resynchronisation Therapy Efficacy Determining Factors for Patients with Moderate and Severe Heart Failure in the Population of Latvia in a 12 and 24 Month Study(2018-12-01) Vikmane, Maija; Kalejs, Oskars; Kamzola, Ginta; Upite, Dana; Ventiņa, Madara; Nesterovičs, Nikolajs; Lejnieks, Aivars; Department of Internal DiseasesThe aim of this study was to evaluate treatment of patients with moderate and severe heart failure (HF) who were resistant to pharmacotherapy in Latvia and to assess the cardiac resynchronisation therapy (CRT) by exploring the predisposing factors which provides CRT efficacy. We accomplished prospective analysis of left ventricle ejection fraction (LVEF) and other parameter changes 12 and 24 months after CRT device implantation, dividing the population into two groups: responders - to whom LVEF improvement was ≥10% and non-responders where ≥ 10% LVEF improvement was not achieved. The study included 50 chronic HF patients with preserved sinus rhythm, who underwent CRT device implantation in Latvia at the Pauls Stradiņš Clinical University Hospital from June 2009 to March 2012. In the group of patients where 12 and 24 months after CRT device implantation LVEF improvement ≥10% was achieved, there were statistically significantly more patients with left bundle branch block (LBBB) QRS morphology, wider QRS complex, nonischemic genesis of HF, and normal systolic blood pressure. Patients with LVEF improvement had more pronounced ventricular dyssynchrony measured by Echo before CRT device implantation and, accordingly, the CRT mode was programmed as left ventricle paced before right ventricle and close to 100% biventricular pacing was achieved and the patient was female.Item Atrial fibrillation recurrence prevention after electrical cardioversion in high-risk patients – benefits of non-antiarrhythmic drugs(2021) Kokina, Baiba; Kalejs, Oskars; Maca, Aija; Strelnieks, Aldis; Jubele, Kristine; Rudaka, Irina; Apsite, Ketija; Lejnieks, Aivars; Faculty of Medicine; Department of Internal Diseases; Residency Unit; Scientific Laboratory of Molecular GeneticsBackground: Recurrence prevention after Atrial Fibrillation (AF) termination by Eelectrical Cardioversion (ECV) remains challenging. Increasing attention is paid to pathophysiological effects of non-Antiarrhythmic Drugs (non-AADs), nevertheless, with heterogeneous results. Objective: We evaluated the potential benefits of different non-AADs as adjunctive therapy to Antiarrhythmic Drugs (AADs) for AF recurrence prevention after sinus rhythm restoration by ECV in high-risk patients. Methods: The study was conducted among high-risk AF patients after successful ECV. Prescription of class IC or class III AAD was required. Data were acquired in a face-to-face baseline interview and 1-, 3-, 6-, 9-, 12-month follow-up interviews. Results: 113 patients were included. Total AF recurrence rate reached 48.7%. Angiotensin-Converting Enzyme Inhibitor (ACEI) or angiotensin receptor blocker (ARB) intake, compared with non-use, demonstrated AF recurrence rate reduction by 8.5% (46.3 vs. 54.8%), with odds ratio (OR) reduced by 28.9% (OR 0.711, 95% confidence interval (CI) 0.310-1.631, p = 0.420). Among mineralocorticoid receptor antagonist (MRA) users, AF recurrence rate was reduced by 25.1% (29.6 vs. 54.7%) and OR by 65.1% (OR 0.349, 95%CI 0.138-0.884, p = 0.023). Present statin therapy reduced AF recurrence rate by 4.2% (46.8 vs. 51.0%) and OR by 15.5% (OR 0.845, 95%CI 0.402-1.774, p = 0.656). Diuretic use showed reduction of AF recurrence rate by 10.2% (41.7 vs. 51.9%) and OR by 33.9% (OR 0.661, 95%CI 0.297-1.469, p = 0.308). Conclusion: Non-AADs demonstrated practical benefits as adjunctive therapy to AADs for AF recurrence prevention after ECV in high-risk patients, with statistically significant results established for concomitant MRA intake.Item Atrial fibrillation, oral anticoagulants and health related quality of life(2018-12) Apsite, Ketija; Luriņa, Baiba; Tupahins, Andris; Voicehovskis, Vladimirs; Ivascenko, Tarass; Kalejs, Oskars; Lejnieks, Aivars; Faculty of Medicine; Department of Internal Diseases; Department of Doctoral StudiesIntroduction: Atrial fibrillation (AFib) is a disease that can influence the health related quality of life. Also oral anticoagulants can influence it both because of its therapeutic benefits or complications as well as how the anticoagulant usage influence the person's life style by regular laboratory test necessity or diet restrictions. Aim: Determine and analyze whether there is a statistically significant difference comparing health related quality of life between K vitamin antagonist, warfarin, users, novel anticoagulant (NOAC), rivaroxaban, dabigatran, users and patients, who do not use any kind of oral anticoagulant. Materials and methods: A cross-sectional analytic research was made in Pauls Stradins Clinical university hospital, Center of Cardiology in Riga, Latvia during the time period from October 2016 till June 2017. Persons with high-risk non-valvular atrial fibrillation were offered to participate in this research. If the person agreed, an oral interview with questions about disease anamnesis, demographic data, laboratory test results, echocardiography results, modified SF-36 survey, used oral anticoagulant type was held. Data were precised with the help of the case anamnesis information. For statistical data analysis was used SPSS Statistics database. Results: Altogether 218 patients were enrolled, of which 56.9% were female and 43.1% – male, mean age – 70.4 years, mean CHA2D2-VASc score – 4.4. Warfarin used 37.6%, 33.0% – novel oral anticoagulants, but 29.4% did not use any kind of oral anticoagulant. A statistically significant difference was discovered between the mean ranks in physical functioning sections comparing warfarin (mean rank 95.85) with NOACs (mean rank 124.57); p = 0.012. Also a statistically significant difference was in social functioning comparing warfarin (mean rank 96.16) with NOACs (mean rank 119.08); p = 0.026. Age had low negative correlation (r = −0.23) with physical functioning. Duration of atrial fibrillation diagnosis did not have correlations with the results. Conclusion: NOAC usage correlates with the best health related quality of life scores, gaining a statistically significant difference compared to warfarin users in physical functioning (warfarin – 95.85, NOACs – 124.57; p = 0.012) and social functioning mean ranks (warfarin – 95.16, NOACs – 119.08; p = 0.026). Age had low negative correlation with physical functioning scores.Item Blood pressure control in treated hypertensive patients in daily practice of Latvian family physicians(2011) Stukena, Inga; Apanavičiene, Daiva Asta; Bahs, Guntis; Kalvelis, Andrejs; Dzerve, Vilnis; Ansmite, Baiba; Kalejs, Oskars; Lejnieks, Aivars; Department of Internal DiseasesBackground and Objective: The aim of this study was to evaluate blood pressure (BP) control level in treated hypertensive patients in Latvia and to compare their characteristics according to the adequacy of BP control. Materials and Methods: Family physicians collected information on demographic and clinical characteristics, and current antihypertensive treatment of 455 18-80-year-old patients with essential arterial hypertension treated for 1 or more years. Target BP was defined as values of <140/90 mm Hg for patients with low or moderate cardiovascular risk and <135/85-125/75 mm Hg for patients with high or very high risk. BP was measured in the office setting after a 5-minute rest in a sitting position using a calibrated aneroid sphygmomanometer. Results: Nearly half of patients (46.2%) attained their target BP. The proportion of patients with effective BP control was higher in the group of low and moderate added cardiovascular risk than in the high and very high added cardiovascular risk group (61.7% vs. 34.4%, P<0.0001). The majority of patients were given two-drug (26.2%) or three-drug (31.6%) combined antihypertensive therapy. Current pharmacological treatment was similar in the patients who attained target BP and in those who did not. Overall, physicians did not modify antihypertensive treatment in 37.9% of patients; such a recommendation was more common among patients with controlled BP. Very few patients (7.4%) who did not attain target BP did not receive recommendations to modify antihypertensive treatment. Conclusions: The rate of effective BP control was less than 50% and was even worse (34.4%) in patients with high or very high added cardiovascular risk in the present sample of treated hypertensive patients.Item A CASE REPORT : PKP2 GENE C.1592T>G VARIATION IN HOMOZYGOUS FORM IDENTIFIED IN ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA PATIENT(Central Bohemia University, 2016) Bidina, Luize; Kupics, Kaspars; Sokolova, Emma; Pavlovics, Mihails; Dobele, Zane; Piekuse, Linda; Kalejs, Oskars; Rīga Stradiņš University; Scientific Laboratory of Molecular GeneticsArrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy. Early recognition and follow up of this disease can reduce sudden cardiac death burden. Arrhythmogenic right ventricular dysplasia is usually inherited as an autosomal dominant trait. We report a case of a young woman aged 26 years with a past history of chest pain and palpitations. During examination, abnormalities were found in results of an electrocardiogram and echocardiography. Genetic testing of the plakophilin 2 (PKP2) gene was done by direct sequencing and genetic variation "NG_009000.1: c.1592T>G" was found in a homozygote form. In family member screening in patients, parents' variation is found in a heterozygote form, where both are healthy. In all reports, "c.1592T>G" is reported only in a heterozygous state, with no known pathogenicity. We consider that this is possibly a pathogenic mutation, inherited as an autosomal recessive trait.Item Catheter ablation or medical therapy to delay progression of atrial fibrillation : The randomized controlled atrial fibrillation progression trial (ATTEST)(2021-03-01) Kuck, Karl Heinz; Lebedev, Dmitry S.; Mikhaylov, Evgeny N.; Romanov, Alexander; Geller, Laszlo; Kalejs, Oskars; Neumann, Thomas; Davtyan, Karapet; On, Young Keun; Popov, Sergey; Bongiorni, Maria Grazia; Schluter, Michael; Willems, Stephan; Ouyang, FeifanAims: Delay of progression from paroxysmal to persistent atrial fibrillation (AF) is an important measure of long-term success of AF treatment. However, published data on the impact of catheter ablation on AF progression are limited. This study evaluates whether radiofrequency (RF) catheter ablation delays the progression of AF compared with antiarrhythmic drug (AAD) treatment using current AF management guidelines. Methods: This prospective, randomized, controlled, two-arm, open-label trial was conducted at 29 hospitals and medical centres across 13 countries. Patients were randomized 1: 1 to RF ablation or AAD treatment. The primary endpoint was the rate of persistent AF/atrial tachycardia (AT) at 3 years. Results: After early study termination following slow enrolment, 255 (79%) of the planned 322 patients were enrolled (RF ablation, n = 128, AAD, n = 127); 36% of patients in the RF ablation group and 41% in the AAD group completed 3 years of follow-up. For the primary endpoint, the Kaplan-Meier estimate of the rate of persistent AF/AT at 3 years was significantly lower with RF ablation [2.4% (95% confidence interval (CI), 0.6-9.4%)] than with AAD therapy [17.5% (95% CI, 10.7-27.9%); one-sided P = 0.0009]. Patients ≥65 years were ∼4 times more likely to progress to persistent AF/AT than patients <65 years, suggesting RF ablation can delay disease progression [hazard ratio: 3.87 (95% CI, 0.88-17.00); P = 0.0727]. Primary adverse events were reported for eight patients in the RF ablation group. Conclusions: Radiofrequency ablation is superior to guideline-directed AAD therapy in delaying the progression from paroxysmal to persistent AF.Item Comparison of effectiveness and safety of antiarrhythmic drugs class IC and III in patients after electrical cardioversion(2019-03-01) Strelnieks, Aldis; Berziņš, Alberts; Karakone, Mara; Pupkeviča, Irina; Jubele, Kristine; Vikmane, Maija; Sakne, Sandis; Kalejs, Oskars; Lejnieks, Aivars; Department of Internal DiseasesPatients with atrial fibrillation are faced with an increased risk of thromboembolic events, myocardial infarction, chronic heart failure and death. For some patients with atrial fibrillation, direct current cardioversion (DCCV) is a strategy that can be used to reacquire sinus rhythm. Our aim was to analyse the most commonly used medications after an electrical cardioversion, the reasons for not using them, the effects of pharmacotherapy on recurrence rates, and compare results with data from studies in 2014. The prospective study includes patients with electrocardiographically confirmed atrial fibrillation who underwent direct current cardioversion, hospitalised at Pauls Stradiņš Clinical University Hospital (Riga, Latvia). The average age was 64.6 years. 50% of the patients were female. During the six-month study period, 14.3% patients were using amiodarone, 8.3% patients were on etacizine, 7.1% received propafenone, and 57.1% used beta blockers in monotherapy or in combination. Warfarin was used in 28.0% patients, direct oral anticoagulants (DOAC's) in 29.9%, 21,4% of patients received aspirin and 16.7% did not use any antithrombotic therapy. Comparing the recurrence rate in patients using different antiarrhythmic drugs, amiodarone showed a statistically significant superiority compared to etacizine and propafenone (p = 0.02). The obtained data showed that over four years, the use of anticoagulants increased by 11.6%.Item Efficacy and safety of non-vitamin K antagonist oral anticoagulants one year after electrical cardioversion(2021) Berzins, Alberts; Knoka, Evija; Nevzorovs, Viesturs; Kalejs, Oskars; Lejnieks, Aivars; Department of Internal DiseasesIntroduction: Atrial fibrillation (AF) is the most common arrhythmia in the world, affecting around 33 million people. Warfarin has been the anticoagulant of choice for the prevention of ischemic stroke in AF patients for a long time. Several large studies have shown that non-vitamin K antagonist oral anticoagulants (NOACs) offer numerous advantages regarding safety and effectiveness, such as fixed dose and more predictable pharmacokinetics. Methods: The study was conducted at Pauls Stradins Clinical University Hospital, Latvian Centre of Cardiology. The study took place from October 2015 to June 2017. A total of 356 patients who had undergone electrical cardioversion (ECV) was included in this study. Results: One year after ECV, 27.5% of patients used warfarin, 33.7% of patients used NOACs, whereas 38.8% did not use any oral anticoagulants. Nine (2.5%) of the patients who participated in the study died during the following year. Overall, eight patients (2.2%) suffered from significant bleeding and three patients (0.8%) had a non-fatal ischemic stroke. The rate of non-fatal ischemic stroke in patients who used warfarin was 2% and no cases were observed in patients who used NOACs (p = 0.20). The rate of significant bleeding was 5.1% versus 2.5% in warfarin and NOAC groups, respectively (p = 0.12). Conclusions: Compared with similar studies, our study showed a low rate of ischemic stroke and significant bleeding, and a low total death rate. One year after ECV, the use of warfarin decreased by 2.8% (p = 0.63), the use of rivaroxaban and dabigatran decreased by 17.5% (p = 0.001) and 17.4% (p = 0.001). The study shows that NOACs are a safe and effective alternative to warfarin.Item Genetic Basis of Early Onset Atrial Fibrillation in Patients without Risk Factors(2023-03) Rudaka, Irina; Vilne, Baiba; Isakova, Jekaterina; Kalejs, Oskars; Gailite, Linda; Rots, Dmitrijs; Scientific Laboratory of Molecular Genetics; Bioinformatics GroupBackground: Atrial fibrillation (AF) is the most common arrhythmia and typically occurs in elderly patients with other cardiovascular and extracardiac diseases. However, up to 15% of AF develops without any related risk factors. Recently, the role of genetic factors has been highlighted in this particular form of AF. Aims: The aims of this study were to determine the prevalence of pathogenic variants in early-onset AF in patients without known disease-related risk factors and to identify any structural cardiac abnormalities in these patients. Materials and Methods: We conducted exome sequencing and interpretation in 54 risk factor-free early-onset AF patients and further validated our findings in a similar AF patient cohort from the UK Biobank. Results: Pathogenic/likely pathogenic variants were found in 13/54 (24%) patients. The variants were identified in cardiomyopathy-related and not arrhythmia-related genes. The majority of the identified variants were TTN gene truncating variants (TTNtvs) (9/13 (69%) patients). We also observed two TTNtvs founder variants in the analysed population—c.13696C>T p.(Gln4566Ter) and c.82240C>T p.(Arg27414Ter). Pathogenic/likely pathogenic variants were found in 9/107 (8%) individuals from an independent similar AF patient cohort from the UK Biobank. In correspondence with our Latvian patients, only variants in cardiomyopathy-associated genes were identified. In five (38%) of the thirteen Latvian patients with pathogenic/likely pathogenic variants, dilation of one or both ventricles was identified on a follow-up cardiac magnetic resonance scan. Conclusions: We observed a high prevalence of pathogenic/likely pathogenic variants in cardiomyopathy-associated genes in patients with risk factor-free early-onset AF. Moreover, our follow-up imaging data indicate that these types of patients are at risk of developing ventricular dilation. Furthermore, we identified two TTNtvs founder variants in our Latvian study population.Item Impact of Metabolic Status on the Course of Atrial Fibrillation(2018-06-01) Dresmane, Renate; Caunite, Laima; Vasiljevs, Aleksandrs; Kalejs, Oskars; Rīga Stradiņš UniversityBackground and aims: Metabolic syndrome (MS) might influence the course of atrial fibrillation (AF) similarly to diabetes (DM). Aim of this research is to evaluate the quality of life, disease burden and medication adherence of patients with different metabolic states. Material and methods: A cross-sectional study of Latvian Center of Cardiology Arrhythmology Department patients with AF, sorting patients in 3 categories according to the National Institutes for Health guidelines criteria for MS. Results: From 133 patients, 51 were in metabolically healthy (MH) group, 58 in MS group and 24 had DM. Average age was 62.59 in MH, 67.59 in MS and 66.25 in DM group. Most common form of AF was persistent - MH 49%, MS 65.5%, DM 75%. Best EHRA median value was observed in DM group (29.2% reporting mild symptoms). Majority of patients had 1-2 comorbidities in MH and MS group and 3-5 in the DM group, with almost all patients using 4-9 drugs daily. Conclusions: A similar course of AF was observed in MS and DM groups. Since the same molecular pathways are involved, MS should be viewed as a cluster of risk factors with a cumulative effect - greater than the effect of a single risk factor.Item Impact of monitoring on detection of arrhythmia recurrences in the ESC-EHRA EORP atrial fibrillation ablation long-term registry(2019-12-01) ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry investigators Group; Balabanski, Tosho; Brugada, Josep; Kalejs, OskarsAims: Monitoring of patients after ablation had wide variations in the ESC-EHRA atrial fibrillation ablation long-term (AFA-LT) registry. We aimed to compare four different monitoring strategies after catheter AF ablation. Methods and results: The ESC-EHRA AFA-LT registry included 3593 patients who underwent ablation. Arrhythmia monitoring during follow-up was performed by 12-lead electrocardiogram (ECG), Holter ECG, trans-telephonic ECG monitoring (TTMON), or an implanted cardiac monitoring (ICM) system. Patients were selected to a given monitoring group according to the most extensive ECG tool used in each of them. Comparison of the probability of freedom from recurrences was performed by censored log-rank test and presented by Kaplan-Meier curves. The rhythm monitoring methods were used among 2658 patients: ECG (N = 578), Holter ECG (N = 1874), TTMON (N = 101), and ICM (N = 105). A total of 767 of 2658 patients (28.9%) had AF recurrences during follow-up. Censored log-rank test discovered a lower probability of freedom from relapses, which was detected with ICM compared to TTMON, ECG, and Holter ECG (P < 0.001). The rate of freedom from AF recurrences was 50.5% among patients using the ICM while it was 65.4%, 70.6%, and 72.8% using the TTMON, ECG, and Holter ECG, respectively. Conclusion: Comparing all main electrocardiographic monitoring methods in a large patient sample, our results suggest that post-ablation recurrences of AF are significantly underreported by TTMON, ECG, and Holter ECG. The ICM estimates AF ablation recurrences most reliably and should be a preferred mode of monitoring for trials evaluating novel AF ablation techniques.Item Lead-related infective endocarditis in Latvia : A single centre experience(2019-09) Nesterovics, Nikolajs; Nesterovics, Georgijs; Stradins, Peteris; Kalejs, Martins; Ansabergs, Janis; Blumbergs, Maris; Maca, Aija; Kamzola, Ginta; Lejnieks, Aivars; Kalejs, Oskars; Erglis, Andrejs; Rīga Stradiņš University; Faculty of MedicineBackground and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.Item Low cardiovascular event rate and high atrial fibrillation recurrence rate one year after electrical cardioversion(2018-06) Knoka, Evija; Pupkevica, Irina; Lurina, Baiba; Kamzola, Ginta; Strelnieks, Aldis; Kalejs, Oskars; Lejnieks, Aivars; Rīga Stradiņš UniversityBackground: Electrical cardioversion is widely used to restore sinus rhythm in patients with atrial fibrillation. However, the long term clinical event and sinus rhythm maintenance rates following electrical cardioversion still remains unclear. This study evaluated one year incidence and risk factors for cardiovascular events and atrial fibrillation recurrence in a single center clinical practice. Methods: In a prospective study 188 patients with atrial fibrillation who underwent electrical cardioversion were enrolled. Patients and their primary care physicians were followed up one year after cardioversion and patient clinical and arrhythmic event rate was evaluated. Data obtained from patients and general practitioners were combined and the results were analyzed with PSPP 0.8.5 software. Results: Electrical cardioversion success rate was 90.4%. Within a year after cardioversion one patient (0.6%) suffered myocardial infarction, three patients (1.9%) had a stroke/transitory ischemic attack (TIA), three patients (1.6%) died and three patients (1.9%) had a bleeding event that required hospitalization. The presence of diabetes mellitus was the only factor with a tendency to increase the risk of combined event of myocardial infarction, stroke/TIA and bleeding (P = 0.096). At follow up 30.0% of patients reported having atrial fibrillation and within a year 62.2% had suffered at least one atrial fibrillation paroxysm. The proportion of patients who underwent additional cardioversions after the initial hospitalization was 32.5%. The factors that significantly increased the risk of atrial fibrillation recurrence were history of stroke/TIA (P = 0.014) and increased left atrial volume index on echocardiography (P = 0.039). Greater left atrial diameter had a tendency toward an increased risk (P = 0.087). Conclusions: Cardiovascular event rate one year after electrical cardioversion was low. Electrical cardioversion had a high immediate success rate, however, maintenance of stable sinus rhythm in the long term was low.Item Methods for detection of direct oral anticoagulants and their role in clinical practice(2019) Pukite, Katrina; Apsite, Ketija; Pupkevica, Irina; Cernevska, Ilze; Boichuk, Oksana; Meisters, Janis; Straupmane, Dagnija; Urtane, Inga; Lejnieks, Aivars; Kalejs, Oskars; Faculty of Medicine; Department of Pharmaceutical Chemistry; Department of Internal DiseasesIntroduction: Atrial fi brillation (AF) is the most common arrhythmia that increases by age, doubles for every decade after age of 50 years and reaches about 10% patients ≥ 80 years.1 Despite direct oral anticoagulants' (DOACs') predictable pharmacokinetics and pharmacodynamics, the laboratory tests are necessary for efective and safe medical treatment, also for prediction and detection of thrombotic and bleeding events, as well as in situations when temporary discontinuation could be desirable.2 Aim: The aim of this study was to identify and analyze the need of coagulation tests for AF patients with high cardiovascular risk in clinical practice. Methods: Quantitative, analytic, cross-sectional clinical trial, during the period from October 2016 till June 2017, was performed at Center of Cardiology, Pauls Stradins Clinical University Hospital, Latvia. There were collected data about patients with non-valvular AF, under anticoagulative therapy ≥3 months, defi ned as a high-risk group by CHA2DS2-VASc score - more or equal to 2 or 3, men and women, respectively. Data were analyzed using SPSS. Results: There were collected data about 143 patients of whom 46.2% (n = 66) were male; the mean age was 69.7 (SD ± 9.9) years. About 2/3 (73.1%) of all patients the AF were longer than 1 year. The mean CHA2DS2-VASc score was 4.2 (SD ± 1.5). The most common comorbidities were arterial hypertension (65.0%; 93), chronic heart failure (48.3%; 69), coronary artery disease (32.9%; 47), diabetes mellitus (24.5%; 35), and dyslipidemia (25.9%; 37). Almost half of patients (46.2%; 66) used DOACs, 31.5% rivaroxaban and 14.7% dabigatran, respectively; furthermore, 1.4% patients used DOACs with antiaggregants. 49.7% (71) patients had increased risk of possible drug-drug interactions, most frequently with proton pump inhibitors (16.8%; 24), amiodarone (24.5%; 35), anti-inflammatory drugs (49.0%; 70). The use of DOACs and possible drug-drug interactions increases by risk score, reaching the maximum score 3 (16.1%; 23) and the mean frequent score 4.4 of 86 (60.1%) AF patients, respectively. The drug concentration in blood was lower than expected, reaching about 75.20% of Cmax. Conclusion: DOACs' usage correlates with CHA2DS2-VASc score with mean frequent score 4.4 of 86 (60.1%) AF patients, respectively. Coagulation tests were applicable more than half of patients (60.1%) to detect DOACs concentration in plasma.Item Oxidative stress, depression, and risk of recurrence of stable coronary heart disease(2021) Ivascenko, Tarass; Voicehovskis, Vladimirs V.; Voicehovska, Julija G.; Skesters, Andrejs; Apsite, Ketija; Grigorjeva, Julija; Kivite-Urtane, Anda; Pahomova, Natalija; Kalejs, Oskars; Rīga Stradiņš UniversityAim: The aim of the study was to investigate the relationships between a level of oxidative stress (OS), depression (D) and risk of recurrence of stable coronary heart disease (SCHD). Methods: A retrospective study was conducted on 174 participants, at the age 45+ years: 86 in-patients of the cardiology department with a recurrent SCHD and 88 in-patients of the cardiology department with primary SCHD. The severity of depressive symptoms was assessed using the long 30-item form of Geriatric Depression Scale (GDS), valid Latvian version of GDS-LAT. The blood samples were taken from each patient to measure oxidative stress parameters malondialdehyde (MDA) and glutathione peroxidase (GPx). Results: 83.9% of the sample had high level of MDA. In 72.4% of the sample the GPx level was normal, in 17.8% it was high and in 9.8% low. Slightly more than a half of the patients were experiencing depression (44.3% – mild D and 6.9% – severe D). GPx was found statistically differing between primary and recurrent SCHD (p = 0,003). Patients with both D and high GPx had 10.6 times higher chances of recurrent SHCD compared to those without D and normal GPx (p = patients with present D were experiencing both – high levels of MDA and GPx – more often than responders with no D, but this wasn’t statistically significant [p = 0.51]). Conclusion: In the present study it was found that level of antioxidant (AO) enzyme GPx was significantly higher in depressed patients with recurrent SCHD compared to patients without D and to patients with primary SCHD and patients with both D and high GPx had higher chances of recurrent SCHD compared to those without D and normal GPx. It could be supposed that GPx is a more significant marker of risk of D and recurrence of SCHD. The high level of MDA in most of both (primary and recurrent SCHD) groups patients could evidence that increased OS is a risk factor for CHD in general. Monitoring OS biomarkers seems to be important in the management of SCHD comorbidity with D. Further studies are warranted to confirm these findings.Item Potential drug-drug interactions between oral anticoagulants for high-risk patients with atrial fibrillation in Latvia(2019) Apsite, Ketija; Pukite, Katrina; Tupahins, Andris; Nikrus, Natalija; Lurina, Baiba; Pupkevica, Irina; Lejnieks, Aivars; Kalejs, Oskars; Faculty of Medicine; Department of Internal DiseasesIntroduction: Atrial fibrillation (AFib) is a disease that affects many people, especially elderly ones. All of these persons have an increased risk of thromboembolic event. For lowering the risk these patients use anticoagulation therapy. There are two types of oral anticoagulants – vitamin K antagonist warfarin and new, known also as direct oral anticoagulants, dabigatran and rivaroxaban. Due to several comorbidities and other complications, e.g. the risk of bleeding and thromboembolism, AFib patients are using different medication simultaneously, therefore increasing the risk of drug-drug interactions because of one metabolism path through P-glycoprotein and CYP450. Monitoring of medical therapy and patient education about most frequent drug-drug interactions using oral anticoagulants could raise attention of health care professionals to the possible drug-drug interactions and promote safe and effective anticoagulation therapy. Aim: To define and analyze the most common potential drug-drug interactions for most frequent used oral anticoagulants – warfarin, dabigatran, rivaroxaban – in patients with high-risk AFib in Latvia. Materials and methods: Quantitative analytic cross-section research was made in time period from October 2016 till June 2017 in Pauls Stradins clinical university hospital, Center of Cardiology in Latvia. The data about patients with high-risk AFib who used oral anticoagulants daily were selected. After signed patients consent form the demographic data, regularly and frequently used medication and food supplements were obtained. Laboratory analysis and echocardiography data were specified with the help of case anamnesis. For statistical data analysis were used SPSS Statistics database. Results: Altogether 143 patients were enrolled in this study, from which 46.2% were male, 53.8% female, with the mean age 69.7 (SD 9.9) years. 53.8% used warfarin, 16.1% dabigatran and 33.6% used rivaroxaban. 49.7% of patients had increased risk of possible drug-drug interactions. For warfarin users the most frequent potential interactions were with omega-3 supplements (20.8%), amiodarone (16.7%) and proton pump inhibitors (13.8%). For dabigatran users the most frequent potential interaction was with proton pump inhibitors (26.1%), amiodarone (17.4%) and omega-3 supplements (13.0%). For rivaroxaban users the most frequent potential drug interaction was with amiodarone (29.2%), omega-3 supplements (16.7%) and non-steroidal anti-inflammatory drugs (4.2%). Conclusion: From all high-risk AFib patients 47.7% had potentially moderate or major risk of drug interactions, most frequently with food supplements. 50.3% patients used warfarin, K vitamin antagonist. The most frequent potential drug interaction in warfarin group was with omega-3 supplements (20.8%) and amiodarone (16.7%), in dabigatran group with proton pump inhibitors (26.1%) and amiodarone (17.4%), in rivaroxaban group with amiodarone (29.2%) and omega-3 supplements (16.7%). Awareness of these interactions between health care professionals could promote the safety and effectiveness of anticoagulation therapy for high-risk atrial fibrillation patients.Item Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population(2015-09-01) Jurjans, Kristaps; Sabelnikova, Santa; Miglane, Evija; Lurina, Baiba; Kalejs, Oskars; Millers, Andrejs; Priede, Zanda; Rīga Stradiņš University; Department of Neurology and NeurosurgeryAtrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Riga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high-40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.Item Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients - Comparative Efficacy of Antiarrhythmic Medications(2021-02-01) Kokina, Baiba; Strelnieks, Aldis; Pupkeviča, Irina; Jubele, Kristine; Vikmane, Maija; Sakne, Sandis; Sokolova, Emma; Urtane, Inga; Lejnieks, Aivars; Kalejs, Oskars; Faculty of Medicine; Department of Internal Diseases; Department of Pharmaceutical ChemistryAtrial fibrillation (AF) conversion to sinus rhythm by electrical cardioversion (ECV) is followed by the challenge of preventing arrhythmia recurrence, especially in high-risk patients. The properties of class IC, class III and also class II antiarrhythmic medications have been established, but not all effects have been studied. The aim of the study was to compare efficacy of class IC and class III antiarrhythmic medications, and additionally medication with a class II mechanism of action, or taken concomitantly with a beta-blocker, for post-cardioversion sinus rhythm maintenance in patients with high-risk AF. A total of 112 patients who underwent successful ECV in Latvian Centre of Cardiology were included. Data was acquired by a face-to-face interview and 1-, 3-, 6-month follow-up interviews. Comparing class IC (used by 34.8%) and class III (used by 65.2%) drugs, there was no statistically significant difference between six-month sinus rhythm maintenance rates (53.8% vs. 63.0%, p = 0.346) and arrhythmia-free survival (p = 0.313). Comparing amiodarone (used by 57.1%) and ethacizine, concurrently with a beta-blocker (used by 25.9%), no statistically significant difference was found between six-month sinus rhythm maintenance (64.1% vs. 58.6%, p = 0.616) and arrhythmia-free survival (p = 0.706). The results showed that specific antiarrhythmic drug choice was not associated with superior effectiveness, highlighting that, if not contraindicated, ethacizine, concomitantly with a beta-blocker, could be used as a similarly effective alternative for amiodarone, which has adverse health effects.