Browsing by Author "Knoka, Evija"

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    Carotid artery stenting outcomes in high-risk patients receiving best medical therapy : Results from a single high-volume interventional cardiology practice
    (2016-12-01) Trusinskis, Karlis; Vasiljevs, Deniss; Knoka, Evija; Sondore, Dace; Dombrovskis, Andis; Kumsars, Indulis; Strenge, Karlis; Bumeistere, Kristine; Kareer, Gurjoat S.; Erglis, Andrejs; Rīga Stradiņš University
    Background Carotid artery stenting (CAS) is now being widely used in the treatment of carotid artery stenosis. Recent clinical studies have demonstrated low adverse event rates after CAS. This study evaluates the 30-day and 1-year results in patients treated with CAS and receiving intensive medical therapy in a high-volume percutaneous coronary intervention center. Methods A total of 184 patients underwent CAS between January 2011 and December 2013. In addition to antiplatelet therapy, patients received intensive antihypertensive treatment, high intensity statin and heart rate normalization therapy. Patients were stratified according to age and symptomatic status. Results Most of the patients (86.4%) had at least one high surgical risk criteria. The procedural success rate was 98.4%. The 30-day and 1-year incidence of stroke were 4.1% and 4.5%, respectively. At 30 days the combined rate of stroke/cardiovascular (CV) death/myocardial infarction (MI) was 5.8% and 10.9% in 1 year. The 30-day incidence of stroke/CV death in asymptomatic and symptomatic patients was 5.4% and 4.2%, respectively. Age ≥80 years increased the risk of stroke/CV death/MI at 1 year (OR 4.41; 95% CI 1.06–18.36; P = 0.04). Conclusions The study demonstrated acceptable clinical outcome results in patients with high medical comorbidities treated with CAS and intensive medical therapy. Adverse event rate in symptomatic patients did not exceed the guideline recommended range while in asymptomatic patients it was increased.
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    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 Diseases
    Introduction: 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.
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    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 University
    Background: 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.
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    Plasma circulating microRNAs in patients with stable coronary artery disease - Impact of different cardiovascular risk profiles and glomerular filtration rates
    (2021-04-22) Trusinskis, Karlis; Lapsovs, Maris; Paeglite, Sandra; Knoka, Evija; Caunite, Laima; Mazule, Mairita; Briede, Ieva; Jegere, Sanda; Kumsars, Indulis; Narbute, Inga; Konrade, Ilze; Erglis, Andrejs; Lejnieks, Aivars; Department of Internal Diseases
    Background and Aim: Plasma circulating microRNA (miRNA)-126, -145, and -155 are associated with vascular remodeling, atherosclerotic lesion formation, and plaque vulnerability. In this study, we evaluated the levels of plasma circulating miRNAs in patients with stable coronary artery disease (CAD), different cardiovascular risk profiles, and different glomerular filtration rates (GFR). Methods and Results: Forty patients with stable CAD admitted for elective percutaneous coronary intervention (PCI) were enrolled in a prospective study. Before PCI, fasting blood samples were obtained to evaluate clinical parameters and miRNA-126 and miRNA-155 expression. The GFR was calculated by the MDRD and CKD-EPI formulas, and the severity of CAD was calculated according to the SYNTAX score. All these parameters were correlated with miRNAs. The association between miRNA levels and clinical characteristics was evaluated. The expression of miRNA-126 positively correlated with a higher SYNTAX score (r = 0.337; p=0.034); however, no significant correlations between miR-126, GFR, and clinical characteristics were observed. Higher plasma levels of miRNA-155 correlated with increased levels of triglycerides (r = 0.317; P = 0.049), C-peptide (r = 0.452; P = 0.011), and the HOMA index (r = 0.447; P = 0.012) and a higher body mass index (BMI) (r = 0.385; P = 0.015). GFR and miRNA-155 (MDRD - Rho=0.353; P = 0.027. CKD-EPI - Rho=0.357; P = 0.026) were found to have a moderate correlation, although miRNA-155 had no correlation with the SYNTAX score. Conclusion: Plasma circulating miRNA-126 levels were increased in patients with severe atherosclerosis as determined by the SYNTAX score. Elevated miRNA-155 expression was observed in patients with Stage 1 GFR but was lower in patients with Stages 2 and 3 GFR. Plasma circulating miRNA-155 had positive correlations with higher levels of BMI, HOMA index, C-peptide, and triglycerides. Relevance for Patients: Although further investigations are needed to confirm the role of miRNA-155 and miRNA-126, they may serve as potential biomarkers detecting severity of CAD, lowering of kidney function and metabolic syndrome.