Browsing by Author "Skride, Andris"

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    Anaesthesia management with deep hypothermia and circulatory arrest during surgery for chronic thromboembolic pulmonary hypertension
    (2014-12-01) Leibuss, Roberts; Kalējs, Mārtiņš; Skride, Andris; Bekkers, Mihails; Ozoliņa, Agnese; Stradiņš, Pēteris; Strīķe, Eva; Lācis, Romans; Rīga Stradiņš University
    Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in 1 to 4% after acute pulmonary embolism. CTEPH can be cured by pulmonary endarterectomy (PEA), which is approved golden standard in chronic condition. There were performed three cases of PEA in Latvian Cardiology Centre during 2013-2014. General anaesthesia under cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrests was provided. The core issue is correct patient selection (in terms of central PA obstruction by thrombus) as well as pulmonary circulation recovery capacity. Neuroprotection was provided by deep hypothermia, topical cooling of the head, Trendelenburg position, mild hypocapnia, Hb 9-10 g/L and pharmacological agents. For screening postoperative cognitive function the mini mental state examination (MMSE) was used before and after the surgery. Postoperative pulmonary vascular resistance index decreased by 56.3% (right ventricular systolic pressure decreased from 93.3 ± 25.7 to 44.5 ± 11.2 mmHg). Before the surgery three patients had NYHA functional class III or IV, at the time of discharge - I or II. In one case moderate (MMSE 18) cognitive disorders was observed at discharge from the ICU. No one died neither in the hospital nor within 30 days of discharge. The surgery improved RV function and pulmonary perfusion with no considerable organ failure, except mild cognitive disorders.
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    Baseline Clinical Characteristics and Incidence of Chronic Thromboembolic Pulmonary Hypertension Patients in Latvia, 2019–2020
    (2023-08-06) Kauliņš, Ričards; Rudzītis, Ainārs; Lejnieks, Aivars; Kigitoviča, Dana; Skride, Andris; Department of Internal Diseases
    Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and progressive condition; however, the true characteristics of CTEPH are still unknown, as notable regional variations exist in terms of patients’ age, baseline hemodynamic data, and management choices. This report aims to investigate the baseline clinical characteristics, incidence, and risk factors associated with CTEPH patients in Latvia from 2019 to 2020. Methods: The data were analyzed from a prospective, nationwide, Latvian pulmonary hypertension registry for incident CTEPH cases. The patients’ clinical characteristics were assessed at the time of diagnosis. Results: During the course of this study, a cohort of 13 patients with CTEPH were included for analysis. Among the enrolled CTEPH patients, most exhibited low exercise and functional capacity, with a median (±IQR) 6 min walk distance of 300.0 (±150.0) m. The median values (±IQR) for mean pulmonary artery pressure and pulmonary vascular resistance were 40.0 ± 13.0 mmHg and 7.35 ± 2.82 Wood units, respectively. The most common risk factors for CTEPH were a history of acute pulmonary embolism and a blood group other than O. Conclusions: The findings of this report revealed the characteristics of the Latvian CTEPH population, indicating that a significant proportion of patients are elderly individuals with multiple comorbidities.
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    Characteristics and survival data from Latvian pulmonary hypertension registry : comparison of prospective pulmonary hypertension registries in Europe
    (2018-07-01) Skride, Andris; Sablinskis, Kristaps; Lejnieks, Aivars; Rudzitis, Ainars; Lang, Irene; Rīga Stradiņš University
    Patient registries are a valuable tool in the research of rare conditions such as pulmonary hypertension (PH). We report comprehensive hemodynamic and survival data of 174 patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), included in the prospective Latvian PH registry over a period of > 9 years. In total, 130 adult PAH patients (75%) and 44 adult CTEPH patients (25%) were enrolled. The median follow-up period was 33 months for PAH and 18 months for CTEPH, P = 0.001. Latvian CTEPH patients had significantly higher plasma levels of B-type natriuretic peptide, higher pulmonary vascular resistance, and lower cardiac index than Latvian PAH patients. Calculated incidence of PAH and CTEPH in Latvia in 2016 was 13.7 and 5.1 cases per million inhabitants, calculated prevalence was 45.7 and 15.7 cases per million inhabitants, respectively. Survival rates at one, three, and five years for PAH patients was 88.0%, 73.3%, and 58.1%, and 83.8%, 59.0%, and 44.2% for CTEPH patients, respectively. We compared our study results with data from European adult PH registries. Latvian PAH patients had the fourth lowest and CTEPH patients the lowest one-year survival rate among European adult PH registries. As most PH registries in Europe are small, yet with equivalent patient inclusion criteria, it would be desirable to combine these registries to produce more reliable and high-quality study results.
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    Choriocarcinoma mimicking chronic thromboembolic pulmonary hypertension
    (2016-05-07) Skride, Andris; Sablinskis, Kristaps; Klepetko, Walter; Lang, Irene; Faculty of Medicine
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    Chronic Thromboembolic Pulmonary Hypertension and Antiphospholipid Syndrome with Immune Thrombocytopenia : A Case Report
    (2018-10-19) Skride, Andris; Sablinskis, Matiss; Sablinskis, Kristaps; Lejniece, Sandra; Lejnieks, Aivars; Klepetko, Walter; Lang, Irene M.; Rīga Stradiņš University
    BACKGROUND Antiphospholipid syndrome is an autoimmune disorder characterized by a hypercoagulable state associated with circulating antiphospholipid antibodies. The presence of antiphospholipid antibodies can result in a variety of clinical symptoms, such as thrombocytopenia, stillbirth, endocardial pathologies, and recurrent pulmonary embolism. CASE REPORT We present the case of a 23-year-old man with antiphospholipid syndrome and chronic thromboembolic pulmonary hypertension who developed severe thrombocytopenia. The patient died from right heart failure before the thrombocytopenia could be managed, preventing performance of a pulmonary endarterectomy procedure. CONCLUSIONS Managing platelet counts in patients with antiphospholipid syndrome prior to major surgery is very problematic, and requires similar treatment strategy as in patients with immune thrombocytic thrombocytopenia. Platelet transfusions may further decrease platelet count, as it can trigger formation of new antibodies.
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    Chronic thromboembolic pulmonary hypertension mimicking acute pulmonary embolism : a case report
    (2021) Kaulins, Ricards; Vitola, Barbara; Lejniece, Sandra; Lejnieks, Aivars; Kigitovica, Dana; Sablinskis, Matiss; Sablinskis, Kristaps; Rudzitis, Ainars; Kalejs, Roberts Verners; Skride, Andris; Department of Internal Diseases
    Objective: Rare disease Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare form of pulmonary hypertension which is often caused by recurrent emboli. The reported prevalence in Latvia is 15.7 cases per million inhabitants. Several risk factors predispose patients to develop chronic thromboembolic pulmonary hypertension, including the presence of chronic myeloproliferative diseases and splenectomy. Case Report: We present a case of a 68-year-old woman with a variant of chronic myeloproliferative disease, essential throm-bocythemia, splenectomy, and chronic thromboembolic pulmonary hypertension, in whom chronic thromboem-bolic pulmonary hypertension was mimicking acute pulmonary embolism. On admission, the patient had pro-gressive dyspnea, elevated right ventricular systolic pressure (RVSP) 60-70 mmHg, and elevated thrombocytes, C-reactive protein, BNP, and d-dimer levels. These results, as well as the results of thoracic computed tomog-raphy angiography with contrast, supported the diagnosis of acute pulmonary embolism. During the sequent follow-up visit after 3 months of effective anticoagulant therapy, the patient had elevated RVSP: 55-60 mmHg. Therefore, right heart catheterization was performed, in which it was found that mPAP was 37 mmHg with PCWP 5 mm Hg and PVR 8.9 Wood units, confirming the CTEPH diagnosis. Conclusions: Patients who are at high risk of thrombosis need an increased level of monitoring to be properly evaluated. An easy solution to misdiagnosis of CTEPH with an acute pulmonary embolism could be taking scrupulous patient history, which can reveal multiple risk factors of CTEPH development. The subsequent assessment of risk factors can lead to a more appropriate consideration of CTEPH diagnosis vs acute pulmonary embolism.
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    Clinical Characteristics and Outcomes of Patients with Lung Cancer and Venous Thromboembolism
    (2018-04) RIETE Investigators; Ruiz-Artacho, Pedro; Trujillo-Santos, Javier; López-Jiménez, Luciano; Font, Carme; Díaz-Pedroche, María Del Carmen; Sánchez Muñoz-Torrero, Juan Francisco; Peris, Maria Luisa; Skride, Andris; Maestre, Ana; Monreal, Manuel
    Background. The natural history of patients with lung cancer and venous thromboembolism (VTE) has not been consistently evaluated. Methods  We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics, time course, and outcomes during anticoagulation of lung cancer patients with acute, symptomatic VTE. Results  As of May 2017, a total of 1,725 patients were recruited: 1,208 (70%) presented with pulmonary embolism (PE) and 517 with deep vein thrombosis (DVT). Overall, 865 patients (50%) were diagnosed with cancer <3 months before, 1,270 (74%) had metastases, and 1,250 (72%) had no additional risk factors for VTE. During anticoagulation (median, 93 days), 166 patients had symptomatic VTE recurrences (recurrent DVT: 86, PE: 80), 63 had major bleeding (intracranial 11), and 870 died. The recurrence rate was twofold higher than the major bleeding rate during the first month, and over threefold higher beyond the first month. Fifty-seven patients died of PE and 15 died of bleeding. Most fatal PEs (84%) and most fatal bleeds (67%) occurred within the first month of therapy. Nine patients with fatal PE (16%) died within the first 24 hours. Of 72 patients dying of PE or bleeding, 15 (21%) had no metastases and 29 (40%) had the VTE shortly after surgery or immobility. Conclusion  Active surveillance on early signs and/or symptoms of VTE in patients with recently diagnosed lung cancer and prescription of prophylaxis in those undergoing surgery or during periods of immobilization might likely help prevent VTE better, detect it earlier, and treat it more efficiently.
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    Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years
    (2019-12-27) The RIETE Investigators; Jara-Palomares, Luis; Ģībietis, Valdis; Kigitoviča, Dana; Skride, Andris
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    Comparisons between Upper and Lower Extremity Deep Vein Thrombosis : A Review of the RIETE Registry
    (2017-10-01) Cote, Lauren P.; Greenberg, Steven; Caprini, Joseph A.; Tafur, Alfonso; Choi, Chris; Muñoz, Francisco J.; Skride, Andris; Valero, Beatriz; Porras, José Antonio; Ciammaichella, Maurizio; Hernández-Blasco, Luis Manuel; Monreal, Manuel
    Background: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). Methods: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the outcomes during the course of anticoagulant therapy in patients with UEDVT versus outcomes in patients with LEDVT. Results: As of August 2015, 37,366 patients with acute DVT had been enrolled in RIETE: 35094 (94%) had LEDVT, 1334 (3.6%) non-catheter related UEDVT (672 unprovoked and 662 provoked) and 938 (2.5%) had catheter-related UEDVT. During the course of anticoagulation, patients with unprovoked UEDVT had a higher rate of DVT recurrences (hazard ratio [HR]: 2.22; 95% CI: 1.37-3.43) and a similar rate of PE recurrences or major bleeding than those with unprovoked LEDVT. Patients with non-catheter-related provoked UEDVT had a similar outcome than those with provoked LEDVT. Among patients with UEDVT, those with non-catheter related unprovoked UEDVT had a lower rate of PE recurrences (HR: 0.06; 95% CI: 0-0.35) and major bleeding (HR: 0.20; 95% CI: 0.08-0.46) than those with catheter-related UEDVT or those with non-catheter related provoked UEDVT (HR: 0.10; 95% CI: 0.004-0.60; and 0.22; 95% CI: 0.08-0.52, respectively). On multivariable analysis, any difference had disappeared. Conclusion: During the course of anticoagulation, patients with UEDVT had a similar outcome than those with LEDVT. Among UEDVT patients, there were some differences according to the presence of catheter or additional risk factors for DVT. These differences disappeared after adjusting for potentially confounding variables.
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    Comprehensive Home-based and Remotely Supervised Physiotherapy Programme within Interdisciplinary Treatment Approach in Patients with Pulmonary Arterial Hypertension. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2023) Butāne, Līna; Šmite, Daina; Skride, Andris
    Introduction. Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease that refers to one of the five subgroups of pulmonary hypertension (PH). PAH refers to a group of rare diseases. PAH is characterized by a progressive course of the disease with increased pulmonary vascular resistance and pulmonary arterial pressure, leading to overload and failure of the right ventricle. The initial clinical symptoms of PAH are commonly induced by exertion and can include shortness of breath, excessive fatigue and weakness, chest pain, and episodes of syncope. Pathologic processes in pulmonary arteries alter oxygen uptake and consumption in the body, decreasing SpO2 and restricting the ability to perform physical activities. Various factors including limited exercise tolerance in combination with muscle weakness, as well as sleep disorders, depression, and inability to adapt to the persistent anxiety caused by severe, chronic, and life-threatening disease, lead to poor quality of life and contribute to social isolation. Today, the appropriate target medical treatment allows patients with PAH not only to survive but also to live a relatively normal life. However, patients face the challenge of adapting and maintaining a good quality of life, thus it is important to consider complex interventions related not only to medical treatment. This study appears to be the first to develop and investigate a comprehensive structured physiotherapy program, which is expected to be implemented in an interdisciplinary treatment approach in patients with PAH in Latvia. Furthermore, the novelty of the thesis obviously shows in the approach used in the study to assess the quality of life of patients with PAH, including the perceived opportunity to live as one wants to in the context of one’s health condition, thus opening opportunities to shed more light on the perspective of the patient on one’s life with a rare, chronic, and life-threatening disease. The aim of the study was to investigate the effectiveness of the comprehensive home-based and remotely supervised physiotherapy program within the interdisciplinary treatment approach to improve and maintain participation in everyday life activities, along with exercise capacity and inspiratory muscle strength, perceived self-efficacy, daily physical activity and sleep quality in patients with PAH. Methods. This is a prospective, randomized, controlled and single-blind study. We recruited patients from the Latvian PH registry with PAH diagnosed by right heart catheterization based on the study inclusion criteria. We randomly assigned the patients to the training group (TG) or the control group (CG). All participants were evaluated at baseline, after 12 weeks and 24 weeks after the start (follow-up). Blinded assessor conducted the assessments in an on-site visit to the University Clinic, and accelerometer data with MOX sensor from 7 consecutive days were obtained too. All participants continued target medical therapy under the supervision of the study cardiologist specialized in PH. Furthermore, TG underwent the developed comprehensive home-based and remotely supervised physiotherapy program led by the study physiotherapist specialized in cardiopulmonology. As primary outcome, perceived autonomy and participation was assessed with the IPA scale. Furthermore, as secondary outcomes 6 minutes walking tests (6MWT), inspiratory muscle strength, perceived self-efficacy, daily physical activity, and sleep quality were evaluated. The choice of mathematical methods of statistics was made in a stepwise fashion, based on small group recommendations. α level 0.05 was chosen; therefore, the results were determined as statistically significant if p < 0.05. For repeated measures, the significance values were adjusted using the Bonferroni correction and set α level 0.025. To measure the effect size, Cohen’s d or rank biserial coefficient was calculated. For statistically significant results, the post hoc statistical power was calculated and a power of at least 80 % (1-β ≥ 0.8) was assumed to be appropriate to control β error. Results. A significant difference between the groups was found in the follow-up assessment in three of four IPA subscales analysed: autonomy outdoors (p = 0.01, rg = 0.66, 1- β = 0.95), family role (p = 0.04, rg = 0.55, 1-β = 0.8), autonomy indoors (p = 0.04, rg = 0.51, 1-β = 0.68) based on median scores. indicating greater limitations of perceived participation in CG compared to TG. The total IPA score significantly decreased in TG after the program: from baseline to 12 weeks assessment (p = 0.005, d = 1.1, 1-β = 0.96), from baseline to follow-up (p = 0.004, d = 1.1, 1-β = 0.97) pointing to improved participation of patients in their everyday life; no significant changes in CG were observed. A significant increase in 6MWT results in TG after 12 weeks and at follow-up. In contrast, no significant improvement was presented in CG. Significant differences in 6MWT results between the groups at 12 weeks and follow-up were approved. Accelerometry data show a significant reduction in sedentary time from baseline to 12 weeks in both groups, and from baseline to follow-up in TG. No significant differences were observed between the groups in sedentary time. Only in TG a significant increase in low or moderate intensity physical activities was observed from baseline to follow-up, and significant difference between groups at follow-up was present in the mentioned activities. Perceived general self-efficacy increased significantly in TG from baseline to 12 weeks; no improvement was present in CG. At follow-up, statistically significant differences between groups were observed, although the results did not reach the appropriate statistical power. Conclusions. In summary, the comprehensive home-based and remotely supervised physiotherapy program within the interdisciplinary treatment approach in patients with PAH prevents the possible deterioration of the perceived participation of patients in activities of their everyday life in the context of one’s health condition and is a resource to encourage the improvement of the perceived opportunity to live life as one wants, despite the long-term impact of PAH and its treatment.
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    Effects of Meldonium on Right Ventricular Failure in a Preclinical Model and Patients. Doctoral Thesis
    (Rīga Stradiņš University, 2023) Kigitoviča, Dana; Skride, Andris; Vilšķērsts, Reinis
    Right ventricular failure (RVF) is associated with poor prognosis and currently has no known treatment. RVF is characterised by pathologically altered myocardial energy metabolism. In turn, modulation of myocardial energy metabolism pathways in heart muscle has been suggested as a promising therapeutic option. Meldonium is a cardiometabolic drug that improves cardiac function in preclinical models of the left-sided heart failure as well as improves the clinical status of heart failure patients. This study was conducted to analyse the incidence of two RVF-inducing diseases, pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), in the Latvian population and to evaluate the effects of meldonium in the preclinical RVF model and in RVF patients. The incidence of PAH and CTEPH was characterised by analysing data from the Latvian PH Registry. The effects of meldonium administration on the development of pulmonary hypertension-induced RVF was assessed in rats after monocrotaline administration. The safety and effects of meldonium treatment on functional capacity and dyspnoea were assessed in patients with PAH-induced RVF. The estimated incidence of PAH in 2021 was 9.5 per million inhabitants and 11.7 per million adult population. The incidence of CTEPH was 4.2 per million inhabitants and 5.0 per million adult population. In preclinical setup, in Sprague-Dawley rats, treatment with meldonium reduced lung-to-body weight index, right ventricle-to-body mass index along with Fulton index (p < 0.05), reduced RV end-systolic area (p < 0.05) and increased RV fractional area change (p < 0.05). In addition, meldonium treatment improved altered mitochondrial bioenergetics in the right ventricular cardiomyocytes. In RVF patients, meldonium treatment significantly improved WHO functional class and SF-36 scores (p < 0.05). Significant increase in walking distance in 6-minute walking test (p = 0.021) and decrease in Borg dyspnoea score after the 6MWT (p = 0.003) were also observed in patients with RVF. The overall incidence of PAH and CPTEH in Latvia has remained stable over the last five years and is in line with other European countries, but the majority of patients are still diagnosed at an advanced stage of the disease. In an experimental model of RVF, treatment with meldonium prevents the development of RVF by improving mitochondrial bioenergetics. In patients with chronic RVF, meldonium treatment is safe and well tolerated and increases functional capacity and decreases dyspnoea.
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    Effects of Meldonium on Right Ventricular Failure in a Preclinical Model and Patients. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2023) Kigitoviča, Dana; Skride, Andris; Vilšķērsts, Reinis
    Right ventricular failure (RVF) is associated with poor prognosis and currently has no known treatment. RVF is characterised by pathologically altered myocardial energy metabolism. In turn, modulation of myocardial energy metabolism pathways in heart muscle has been suggested as a promising therapeutic option. Meldonium is a cardiometabolic drug that improves cardiac function in preclinical models of the left-sided heart failure as well as improves the clinical status of heart failure patients. This study was conducted to analyse the incidence of two RVF-inducing diseases, pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), in the Latvian population and to evaluate the effects of meldonium in the preclinical RVF model and in RVF patients. The incidence of PAH and CTEPH was characterised by analysing data from the Latvian PH Registry. The effects of meldonium administration on the development of pulmonary hypertension-induced RVF was assessed in rats after monocrotaline administration. The safety and effects of meldonium treatment on functional capacity and dyspnoea were assessed in patients with PAH-induced RVF. The estimated incidence of PAH in 2021 was 9.5 per million inhabitants and 11.7 per million adult population. The incidence of CTEPH was 4.2 per million inhabitants and 5.0 per million adult population. In preclinical setup, in Sprague-Dawley rats, treatment with meldonium reduced lung-to-body weight index, right ventricle-to-body mass index along with Fulton index (p < 0.05), reduced RV end-systolic area (p < 0.05) and increased RV fractional area change (p < 0.05). In addition, meldonium treatment improved altered mitochondrial bioenergetics in the right ventricular cardiomyocytes. In RVF patients, meldonium treatment significantly improved WHO functional class and SF-36 scores (p < 0.05). Significant increase in walking distance in 6-minute walking test (p = 0.021) and decrease in Borg dyspnoea score after the 6MWT (p = 0.003) were also observed in patients with RVF. The overall incidence of PAH and CPTEH in Latvia has remained stable over the last five years and is in line with other European countries, but the majority of patients are still diagnosed at an advanced stage of the disease. In an experimental model of RVF, treatment with meldonium prevents the development of RVF by improving mitochondrial bioenergetics. In patients with chronic RVF, meldonium treatment is safe and well tolerated and increases functional capacity and decreases dyspnoea.
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    Glomerular filtration rate as a prognostic factor for long-term mortality after acute pulmonary embolism
    (2019-06-01) Ģibietis, Valdis; Kigitoviča, Dana; Vitola, Barbara; Strautmane, Sintija; Skride, Andris; Department of Internal Diseases; Residency Unit
    Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919-0.979; 1-year: HR 0.967, 95% CI 0.943-0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915-0.983; 1-year: HR 0.971, 95% CI 0.945-0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.
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    Health care accessibility and disparities in medical staff availability in Latvia
    (2019) Bikava, Ieva; Skride, Andris; Berķis, U.; Vilka, L.; Rīga Stradiņš University; Department of Internal Diseases
    The Health care accessibility for inhabitants, especially in rural regions, is related to the problem of the medical staff availability in state and municipal hospitals and ambulatory institutions as well as for General Practitioners. Despite the fact, that there are two state Universities – University of Latvia and Rıga Stradiņš University, as well as colleges, that educate medical staff – there is a lack of human resources in health care institutions in Latvia. The Ministry of Health and municipalities had several initiatives to solve this problem – changes in regulations for Residency students, programme financed by European Funds with obtainable funding in the amount of 10 million euro, as well as different stimuli and programmes from municipalities. The research explores the current situation with staff availability and, basing on interviews and outcomes, analyzes the effectiveness of the available programmes to attract human resources, and predict the impact and outcomes of those activities. The results showed that all the programmes had some fragmented positive impact and partially solve the problem, but those activities will not provide sufficient outcomes and the problem of medical staff availability will still be the urgent topic in future.
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    Hemodinamisko rādītāju novērtēšana un mirstības riska faktoru identifikācija pacientiem ar pulmonālu arteriālu un hronisku trombembolisku pulmonālu hipertensiju. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2018) Skride, Andris; Lejnieks, Aivars
    Pulmonālā hipertensija (PH) ir smaga, dzīvību apdraudoša slimība, kurai ir raksturīgi augsti mirstības rādītāji un kuras ārstēšanā ir nepieciešama multidisciplināra pieeja. PH pamatkritērijs ir palielināts vidējais spiediens plaušu artērijās – ≥25 mmHg miera stāvoklī, kas noteikts sirds labās daļas katetrizācijas laikā. Mūsdienās PH tiek klasificēta 5 grupās saskaņā ar Pasaules Veselības organizācijas (PVO) apstiprināto klasifikāciju. Vislabāk izpētītās PH grupas ir 1. grupa – pulmonāla arteriāla hipertensija (PAH) un 4. grupa – hroniska trombemboliska pulmonāla hipertensija (HTEPH). Abas slimības grupas ir pieskaitāmas retajām slimībām. Promocijas darba ietvaros 2007. gadā tika uzsākta sistemātiska PAH un HTEPH pacientu datu apkopošana dzīvildzes un mirstības riska faktoru noteikšanai. Pētnieciskais darbs ir deviņu gadu garumā iegūto datu analīze. Darba mērķis. Identificēt mirstības riska faktorus pacientiem ar PAH un HTEPH diagnozi. Darba hipotēzes. Pacientu dzīvildzi ietekmē sirds katetrizācijas laikā noteiktie hemodinamiskie rādītāji: spiediens labajā priekškambarī, pulmonālā vaskulārā rezistence, sirds minūtes indekss, sirds minūtes tilpums kā arī dzimums, vecums, funkcionālā kapacitāte diagnozes brīdī; mirstības rādītāji dažādās PAH apakšgrupās ir atšķirīgi, augstākie – pacientiem ar idiopātisku PAH un PAH saistībā ar sistēmas saistaudu slimībām. Darba metodes. Prospektīvs viena centra novērojuma tipa pētījums par PAH un HTEPH klīnisko manifestāciju, hemodinamiskajiem un dzīvildzes rādītājiem. Galvenie darba rezultāti. Laika periodā no 2007. gada 1. septembra līdz 2016. gada 31. decembrim, veicot sirds labās daļas katetrizāciju, pētījuma ietvaros PH tika apstiprināta 503 pacientiem, no kuriem pētījuma iekļaušanas kritērijiem atbilda 130 PAH un 44 HTEPH pacienti. PAH grupā 27 % (n=35) pacientu bija vīrieši, HR – 1,13 (0,57–2,21); vecums – 65 (47–71) gadi, HR, vecumam pieaugot par 1 gadu, – 1,01 (0,99–1,03); sešu minūšu iešanas testa rezultāts 322 ± 122 m; HR rezultātam ≤ 300 m – 3,36 (1,27–8,89); vidējais spiediens plaušu artērijās – 49 ± 18 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,00 (0,99–1,02); spiediens labajā priekškambarī – 11 ± 7 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,10 (1,05–1,16); pulmonālā vaskulārā rezistence – 6,6 (4,4–10,9) WU, HR, rezistencei pieaugot par 1 WU, – 1,02 (0,96–1,08); sirds minūtes indekss – 2,47 ± 0,73 l/min/m2, HR, sirds minūtes indeksam pieaugot par 1 l/min/m2, – 1,02 (0,64–1,61). HTEPH pacientu grupas parametru vērtības un to mirstības draudu attiecība: 39 % (n=17) pacientu bija vīrieši, HR – 0,72 (0,22–2,36); vecums – 67 (47–73) gadi, HR, vecumam pieaugot par 1 gadu, – 0,97 (0,94–1,00); sešu minūšu iešanas testa rezultāts – 274 ± 111 m; HR rezultātam ≤ 300 m – 1,91 (0,73–4,64); vidējais spiediens plaušu artērijās – 51 ± 15 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,05 (1,01–1,10); spiediens labajā priekškambarī – 13 ± 8 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,07 (0,99–1,14); pulmonālā vaskulārā rezistence – 10,3 (6,9–13,8) WU, HR, rezistencei pieaugot par 1 WU, – 1,13 (1,00–1,27); sirds minūtes indekss – 1,93 ± 0,74 l/min/m2, HR, sirds minūtes indeksam pieaugot par 1 l/min/m2, – 0,90 (0,31–2,61). Viena, trīs un piecu gadu dzīvildze PAH pacientu grupā bija 88 %, 84 %, 73 % un HTEPH grupā – 76 %, 58 %, 44 %. Secinājumi. Pulmonālas arteriālas hipertensijas un hroniskas tromboemboliskas pulmonālas hipertensijas pacientu prognozi ietekmē atsevišķi sirds katetrizācijas laikā noteiktie hemodinamiskie rādītāji, daļēji apstiprinot pētījuma sākumā izvirzīto hipotēzi. Pulmonālas arteriālas hipertensijas pacientiem statistiski nozīmīgi palielinātas mirstības riska kritēriji ir zems 6 minūšu iešanas testa rezultāts (īpaši < 300 m) un palielināts spiediens labajā priekškambarī. Hroniskas tromboemboliskas pulmonālas hipertensijas grupā statistiski nozīmīgi palielinātas mirstības riska kritēriji ir mazāks vecums (≤ 65 gadi), augstāks vidējais spiediens plaušu artērijās, kā arī lielāka pulmonālās vaskulārās rezistences vērtība. PAH pacientu grupā zems 6 minūšu iešanas testa rezultāts un palielināts spiediens labajā priekškambarī tika identificēti kā neatkarīgi mirstības riska faktori. Aprēķinātā 1 gada dzīvildze PAH pacientiem Latvijā ir otra zemākā no ziņotajām Eiropā, savukārt HTEPH grupā tā ir viszemākā Eiropā. Uz pētījuma bāzes ir izveidots valsts pulmonālās hipertensijas un tās apakšgrupu reģistrs.
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    Hemodinamisko rādītāju novērtēšana un mirstības riska faktoru identifikācija pacientiem ar pulmonālu arteriālu un hronisku trombembolisku pulmonālu hipertensiju. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2018) Skride, Andris; Lejnieks, Aivars
    Pulmonālā hipertensija (PH) ir smaga, dzīvību apdraudoša slimība, kurai ir raksturīgi augsti mirstības rādītāji un kuras ārstēšanā ir nepieciešama multidisciplināra pieeja. PH pamatkritērijs ir palielināts vidējais spiediens plaušu artērijās – ≥25 mmHg miera stāvoklī, kas noteikts sirds labās daļas katetrizācijas laikā. Mūsdienās PH tiek klasificēta 5 grupās saskaņā ar Pasaules Veselības organizācijas (PVO) apstiprināto klasifikāciju. Vislabāk izpētītās PH grupas ir 1. grupa – pulmonāla arteriāla hipertensija (PAH) un 4. grupa – hroniska trombemboliska pulmonāla hipertensija (HTEPH). Abas slimības grupas ir pieskaitāmas retajām slimībām. Promocijas darba ietvaros 2007. gadā tika uzsākta sistemātiska PAH un HTEPH pacientu datu apkopošana dzīvildzes un mirstības riska faktoru noteikšanai. Pētnieciskais darbs ir deviņu gadu garumā iegūto datu analīze. Darba mērķis. Identificēt mirstības riska faktorus pacientiem ar PAH un HTEPH diagnozi. Darba hipotēzes. Pacientu dzīvildzi ietekmē sirds katetrizācijas laikā noteiktie hemodinamiskie rādītāji: spiediens labajā priekškambarī, pulmonālā vaskulārā rezistence, sirds minūtes indekss, sirds minūtes tilpums kā arī dzimums, vecums, funkcionālā kapacitāte diagnozes brīdī; mirstības rādītāji dažādās PAH apakšgrupās ir atšķirīgi, augstākie – pacientiem ar idiopātisku PAH un PAH saistībā ar sistēmas saistaudu slimībām. Darba metodes. Prospektīvs viena centra novērojuma tipa pētījums par PAH un HTEPH klīnisko manifestāciju, hemodinamiskajiem un dzīvildzes rādītājiem. Galvenie darba rezultāti. Laika periodā no 2007. gada 1. septembra līdz 2016. gada 31. decembrim, veicot sirds labās daļas katetrizāciju, pētījuma ietvaros PH tika apstiprināta 503 pacientiem, no kuriem pētījuma iekļaušanas kritērijiem atbilda 130 PAH un 44 HTEPH pacienti. PAH grupā 27 % (n=35) pacientu bija vīrieši, HR – 1,13 (0,57–2,21); vecums – 65 (47–71) gadi, HR, vecumam pieaugot par 1 gadu, – 1,01 (0,99–1,03); sešu minūšu iešanas testa rezultāts 322 ± 122 m; HR rezultātam ≤ 300 m – 3,36 (1,27–8,89); vidējais spiediens plaušu artērijās – 49 ± 18 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,00 (0,99–1,02); spiediens labajā priekškambarī – 11 ± 7 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,10 (1,05–1,16); pulmonālā vaskulārā rezistence – 6,6 (4,4–10,9) WU, HR, rezistencei pieaugot par 1 WU, – 1,02 (0,96–1,08); sirds minūtes indekss – 2,47 ± 0,73 l/min/m2, HR, sirds minūtes indeksam pieaugot par 1 l/min/m2, – 1,02 (0,64–1,61). HTEPH pacientu grupas parametru vērtības un to mirstības draudu attiecība: 39 % (n=17) pacientu bija vīrieši, HR – 0,72 (0,22–2,36); vecums – 67 (47–73) gadi, HR, vecumam pieaugot par 1 gadu, – 0,97 (0,94–1,00); sešu minūšu iešanas testa rezultāts – 274 ± 111 m; HR rezultātam ≤ 300 m – 1,91 (0,73–4,64); vidējais spiediens plaušu artērijās – 51 ± 15 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,05 (1,01–1,10); spiediens labajā priekškambarī – 13 ± 8 mmHg, HR, spiedienam pieaugot par 1 mmHg, – 1,07 (0,99–1,14); pulmonālā vaskulārā rezistence – 10,3 (6,9–13,8) WU, HR, rezistencei pieaugot par 1 WU, – 1,13 (1,00–1,27); sirds minūtes indekss – 1,93 ± 0,74 l/min/m2, HR, sirds minūtes indeksam pieaugot par 1 l/min/m2, – 0,90 (0,31–2,61). Viena, trīs un piecu gadu dzīvildze PAH pacientu grupā bija 88 %, 84 %, 73 % un HTEPH grupā – 76 %, 58 %, 44 %. Secinājumi. Pulmonālas arteriālas hipertensijas un hroniskas tromboemboliskas pulmonālas hipertensijas pacientu prognozi ietekmē atsevišķi sirds katetrizācijas laikā noteiktie hemodinamiskie rādītāji, daļēji apstiprinot pētījuma sākumā izvirzīto hipotēzi. Pulmonālas arteriālas hipertensijas pacientiem statistiski nozīmīgi palielinātas mirstības riska kritēriji ir zems 6 minūšu iešanas testa rezultāts (īpaši < 300 m) un palielināts spiediens labajā priekškambarī. Hroniskas tromboemboliskas pulmonālas hipertensijas grupā statistiski nozīmīgi palielinātas mirstības riska kritēriji ir mazāks vecums (≤ 65 gadi), augstāks vidējais spiediens plaušu artērijās, kā arī lielāka pulmonālās vaskulārās rezistences vērtība. PAH pacientu grupā zems 6 minūšu iešanas testa rezultāts un palielināts spiediens labajā priekškambarī tika identificēti kā neatkarīgi mirstības riska faktori. Aprēķinātā 1 gada dzīvildze PAH pacientiem Latvijā ir otra zemākā no ziņotajām Eiropā, savukārt HTEPH grupā tā ir viszemākā Eiropā. Uz pētījuma bāzes ir izveidots valsts pulmonālās hipertensijas un tās apakšgrupu reģistrs.
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    Hemodynamic Parameter Assessment and Mortality Risk Factor Identification in Patients with Pulmonary Arterial and Chronic Thromboembolic Pulmonary Hypertension. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2018) Skride, Andris; Lejnieks, Aivars
    Pulmonary hypertension (PH) is a debilitating disease associated with high mortality requiring multidisciplinary approach. PH is defined by a mean pulmonary artery pressure ≥ 25 mmHg at rest, measured during right heart catheterization. Nowadays, PH is classified into 5 groups. The best studied types of PH are group 1 – pulmonary arterial hypertension (PAH) and group 4 – chronic thromboembolic pulmonary hypertension (CTEPH). Both PAH and CTEPH are also classified as rare diseases. Systematic data collection of PAH and CTEPH patients began in 2007 as a part of PhD research. This paper presents the data obtained over period of nine years. Aim. The purpose of this study was identify mortality risk factors for PAH and CTEPH patients in Latvia. Methods. This is a prospective, single–center study of PAH and CTEPH patient clinical manifestation, hemodynamic parameters and survival rate at the time of diagnosis. Results. From September 1, 2007 to December 31, 2016 PH was confirmed in 503 cases. 130 patients with PAH and 44 patients with CTEPH satisfied the inclusion (exclusion) criteria and were included in present study. In PAH patient group 27 % (n=35) of patients were male, HR – 1.13 (0.57–2.21); median age was 65 (47–71) years, HR per 1 year – 1.01 (0.99–1.03); mean six–minute walk test result – 322 ± 122 m; HR for a result ≤ 300 m – 3.36 (1.27–8.89); mean pulmonary artery pressure – 49 ± 18 mmHg, HR per 1 mmHg – 1.00 (0.99–1.02); mean right atrial pressure– 11 ± 7 mmHg, HR per 1 mmHg – 1.10 (1.05–1.16); median pulmonary vascular resistance – 6.6 (4.4–10.9) WU, HR per 1 WU – 1.02 (0.96–1.08); mean cardiac index – 2.47 ± 0.73 l/min/m2, HR per 1 l/min/m2 – 1.02 (0.64–1.61). In CTEPH patient group 39 % (n=17) of patients were male, HR – 0.72 (0.22–2.36); median age was 67 (47–73) years, HR per 1 year – 0.97 (0.94–1.00); mean six–minute walk test result – 274 ± 111 m; HR for a result ≤ 300 m – 1.91 (0.73–4.64); mean pulmonary artery pressure – 51 ± 15 mmHg, HR per 1 mmHg – 1.05 (1.01–1.10); mean right atrial pressure — 13 ± 8 mmHg, HR per 1 mmHg – 1.07 (0.99–1.14); median pulmonary vascular resistance – 10.3 (6.9–13.8) WU, HR per 1 WU – 1.13 (1.00–1.27); mean cardiac index – 1.93 ± 0.74 l/min/m2, HR per 1 l/min/m2 – 0.90 (0.31–2.61). One, three and five year survival rate in PAH and CTEPH patient groups were: 88 % and 84 %, 73 % and 76 %, 58 % and 44 %, respectively. Conclusions. Survival prognosis of PAH and CTEPH patients depends on several hemodynamic parameters obtained during right heart catheterization, partially confirming that the hypothesis made at the beginning of study is correct. In PAH patient group both lower 6 minute walk test result (especially ≤ 300 m) and higher right atrial pressure were associated with increased mortality. In CTEPH patient group lower age (≤ 65 years), higher mean pulmonary artery pressure and higher pulmonary vascular resistance were associated with increased mortality. Multivariate analysis showed that in PAH patient group lower 6 minute walk test result and higher right atrial pressure were independently associated with increased mortality. Latvian PAH patients had the second worst 1–year survival among those reported in Europe and in CTEPH patient group it was the worst among reported. A state–level PH and its subgroup registry was created in Latvia based on current study and its data.
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    Idiopathic pulmonary arterial hypertension phenotypes determined by cluster analysis from the COMPERA registry
    (2020-12) Hoeper, Marius M.; Pausch, Christine; Grünig, Ekkehard; Klose, Hans; Staehler, Gerd; Huscher, Doerte; Pittrow, David; Olsson, Karen M.; Vizza, Carmine Dario; Gall, Henning; Benjamin, Nicola; Distler, Oliver; Opitz, Christian; Gibbs, J. Simon R.; Delcroix, Marion; Ghofrani, H. Ardeschir; Rosenkranz, Stephan; Ewert, Ralf; Kaemmerer, Harald; Lange, Tobias J.; Kabitz, Hans Joachim; Skowasch, Dirk; Skride, Andris; Jureviciene, Elena; Paleviciute, Egle; Miliauskas, Skaidrius; Claussen, Martin; Behr, Juergen; Milger, Katrin; Halank, Michael; Wilkens, Heinrike; Wirtz, Hubert; Pfeuffer-Jovic, Elena; Harbaum, Lars; Scholtz, Werner; Dumitrescu, Daniel; Bruch, Leonhard; Coghlan, Gerry; Neurohr, Claus; Tsangaris, Iraklis; Gorenflo, Matthias; Scelsi, Laura; Vonk-Noordegraaf, Anton; Ulrich, Silvia; Held, Matthias; Rīga Stradiņš University
    The term idiopathic pulmonary arterial hypertension (IPAH) is used to categorize patients with pre-capillary pulmonary hypertension of unknown origin. There is considerable variability in the clinical presentation of these patients. Using data from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension, we performed a cluster analysis of 841 patients with IPAH based on age, sex, diffusion capacity of the lung for carbon monoxide (DLCO; <45% vs ≥45% predicted), smoking status, and presence of comorbidities (obesity, hypertension, coronary heart disease, and diabetes mellitus). A hierarchical agglomerative clustering algorithm was performed using Ward's minimum variance method. The clusters were analyzed in terms of baseline characteristics; survival; and response to pulmonary arterial hypertension (PAH) therapy, expressed as changes from baseline to follow-up in functional class, 6-minute walking distance, cardiac biomarkers, and risk. Three clusters were identified: Cluster 1 (n = 106; 12.6%): median age 45 years, 76% females, no comorbidities, mostly never smokers, DLCO ≥45%; Cluster 2 (n = 301; 35.8%): median age 75 years, 98% females, frequent comorbidities, no smoking history, DLCO mostly ≥45%; and Cluster 3 (n = 434; 51.6%): median age 72 years, 72% males, frequent comorbidities, history of smoking, and low DLCO. Patients in Cluster 1 had a better response to PAH treatment than patients in the 2 other clusters. Survival over 5 years was 84.6% in Cluster 1, 59.2% in Cluster 2, and 42.2% in Cluster 3 (unadjusted p < 0.001 for comparison between all groups). The population of patients diagnosed with IPAH is heterogenous. This cluster analysis identified distinct phenotypes, which differed in clinical presentation, response to therapy, and survival.
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    Ikdienā integrēta un attālināti pārraudzīta fizioterapijas programma starpdisciplināras ārstēšanas pieejā pacientiem ar pulmonālo arteriālo hipertensiju. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2023) Butāne, Līna; Šmite, Daina; Skride, Andris
    Ievads. Pulmonālā arteriālā hipertensija (PAH) pieder reto slimību grupai, un to raksturo progresējoša gaita ar paaugstinātu plaušu artēriju rezistenci un pieaugošu asinsspiedienu plaušu artērijās, kam seko sirds labā kambara pārslodze un mazspēja. Slimības simptomi, slodzes tolerance, hemodinamiskie rādītāji ir tikai aisberga redzamā daļa no kopējās PAH radītās negatīvās ietekmes uz pacienta dzīvi, aktualizējot starpdisciplināras un kompleksas ārstēšanas pieejas nepieciešamību. Pacientu ar PAH ārstēšanā nepieciešams apvienot gan specializētas veselības aprūpes pakalpojumus, gan ilgtermiņa intervences, kas vērstas uz hroniskas slimības pārvaldības spējas uzlabošanu un dinamisku adaptāciju. Tas aktualizē nepieciešamību veidot kompleksas fizioterapijas intervences, kas mērķētas ne tikai uz fizisko funkciju uzlabošanu, bet arī uz slimības pašpārvaldes veicināšanu un veselīgu ikdienas ieradumu veidošanu. Šis ir Latvijā pirmais pētījums par starpdisciplināru pieeju pacientu ar PAH ārstēšanā, mērķa medikamentozo terapiju apvienojot ar kompleksu, ikdienā iekļautu un attālināti pārraudzītu fizioterapijas programmu. Turklāt pētījumā izmantotā pieeja pacientu ar PAH dzīves kvalitātes izvērtēšanā, ietverot pašvērtējumu par izjusto iespēju piedalīties savā ikdienas dzīvē kontekstā ar veselības stāvokli, līdz šim nav bijusi aktualizēta, tādējādi paverot iespējas plašāk izgaismot pacienta perspektīvu par dzīvi ar retu, dzīvību apdraudošu un hronisku slimību. Mērķis. Izpētīt ikdienā integrētas, attālināti pārraudzītas fizioterapijas programmas efektivitāti starpdisciplināras ārstēšanas pieejā, lai uzlabotu un saglabātu pacientu ar PAH izjusto iespēju piedalīties savā ikdienas dzīvē, saistībā ar veselības stāvokli, paaugstinot fizisko funkciju rādītājus, izjusto pašefektivitāti, kā arī pilnveidojot fizisko aktivitāšu ieradumus un miega kvalitāti. Materiāli un metodes. Šis bija kontrolēts nejaušināts pētījums ar prospektīvu datu vākšanu laika periodā no 2020. gada februāra līdz 2020. gada septembrim, kurā tika analizēta izveidotā 12 nedēļu garā kompleksā fizioterapijas programma, kas ietvēra četrus pamatelementu: fiziskos vingrojumus; relaksācijas metodes; paškontroli un pašpārvaldi; izglītošanu un pārraudzību. Programma tika realizēta mājas vidē, integrēta pacienta ikdienas dzīvē un attālināti pārraudzīta. Dalībnieku izlase tika izveidota no Latvijas Pulmonālās hipertensijas reģistrā esošajiem pacientiem, balstoties uz definētajiem iekļaušanas kritērijiem. Izveidotā izlase tika nejaušināti sadalīta terapijas (n = 11) un kontroles grupā (n = 10) (turpmāk TG un KG). Abām grupām tika turpināta medikamentozā terapija, bet TG dalībniekiem papildus tika pievienota izveidotā fizioterapijas programma. Dalībnieku novērtēšana tika veikta trīs reizes – sākotnēji, pēc 12 nedēļām un atkārtoti (24 nedēļas kopš sākuma). Primārais rezultātu mērījums bija izjustās autonomijas un līdzdalības ierobežojuma izvērtējums ar IPA anketu, savukārt sekundārie rezultātu mērījumi ietvēra fizisko funkciju novērtējumu: 6 minūšu iešanas testā (6MIT) noietais attālums un desaturācija; ieelpas muskuļu spēks (cm H2O); izjustās pašefektivitātes izvērtējums ar GSE anketu; ikdienas fizisko aktivitāšu novērtējums ar akselerometriju; miega kvalitātes pašvērtējums (PSQI). Matemātiskās statistikas metožu izvēle tika veikta, ievērojot pakāpienu principu, vadoties pēc ieteikumiem mazo izlašu pētījumiem. Datu analīze veikta statistiskās nozīmības līmenī p < 0,05, savukārt atkārtotajiem mērījumiem tika piemērota Bonferroni korekcija (p < 0,025). Lai noteiktu efekta lielumu, tika aprēķināts Cohen’s d vai Glass rank biserial coefficient (rg), un statistiski nozīmīgiem rezultātiem post hoc analīzē tika noteikta statistiskā jauda, pieņemot, ka jauda vismaz 80 % (1- β ≥ 0,8) ir piemērota β kļūdas kontrolei. Rezultāti. Atkārtotajā novērtējumā tika vērota statistiski nozīmīga atšķirība starp grupām trijās IPA apakšskalās: autonomija ārpus mājas (p = 0,01, rg = 0,66, 1-β = 0,95), loma ģimenē (p = 0,04, rg = 0,55, 1-β = 0,8), autonomija mājās (p = 0,04, rg = 0,51, 1-β = 0,68), norādot uz lielākiem izjustās līdzdalības ierobežojumiem KG dalībniekiem, salīdzinot ar TG dalībniekiem. IPA summārajā rezultātā tika konstatēts statistiski nozīmīgs izjusto ierobežojumu samazinājums tikai TG gan pēc 12 nedēļām (vidēji par 4,4 % (TI 1,6–7,1)), gan atkārtotajā novērtējumā (vidēji par 5,8 % (TI 2,3–9,2)). Tikai TG novēroja statistiski nozīmīgu 6MIT noietā attāluma uzlabojumu: pēc 12 nedēļām vidēji par 51,8 m (TI 25,7–77,9; p < 0,001; d = 1,7), bet atkārtotajā novērtējumā vidēji par 75,5 m (TI 46,1–104,8; p < 0,001; d = 2,1), liecinot par klīniski nozīmīgu uzlabojumu. Kā arī tikai TG novēroja statistiski nozīmīgu ieelpas muskuļu spēka pieaugumu gan pēc 12 nedēļām – vidēji par 9,8 cm H2O (TI 6,9–12,7; p < 0,001; d = 2,2) –, gan atkārtotajā novērtējumā – vidēji par 10,5 cm H2O (TI 7,6–13,5; p < 0,001; d = 2,4). Statistiski nozīmīgu GSE pieaugumu konstatēja tikai TG pēc 12 nedēļām – vidēji par 9,4 % (TI 3,7–15,0; p = 0,004; d = 1,04). Akselerometrijas rezultāti uzrādīja nozīmīgu mazkustīgi pavadītā laika samazinājumu abās grupās, savukārt nozīmīgu zemas un vidējas intensitātes aktivitāšu pieaugumu tikai TG. Vienlaikus TG novērtējumā pēc 12 nedēļām tika vērota statistiski nozīmīga miega kvalitātes uzlabošanās (p = 0,013, rc = 0,76). Secinājumi. Kopumā pētījumā iegūtie rezultāti apliecina, ka pētītā fizioterapijas programma, kas tika realizēta starpdisciplināras ārstēšanas pieejā, aizkavē pacientu ar PAH izjustās līdzdalības pasliktināšanos ikdienas dzīves aktivitātēs, kā arī veido resursu, lai pacients ar PAH varētu uzlabot savas iespējas piedalīties ikdienas dzīves aktivitātēs tādā veidā, kā vēlas, neņemot vērā PAH un tās ārstēšanas ilgtermiņa ietekmi.
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    Ikdienā integrēta un attālināti pārraudzīta fizioterapijas programma starpdisciplināras ārstēšanas pieejā pacientiem ar pulmonālo arteriālo hipertensiju. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2023) Butāne, Līna; Šmite, Daina; Skride, Andris
    Ievads. Pulmonālā arteriālā hipertensija (PAH) pieder reto slimību grupai, un to raksturo progresējoša gaita ar paaugstinātu plaušu artēriju rezistenci un pieaugošu asinsspiedienu plaušu artērijās, kam seko sirds labā kambara pārslodze un mazspēja. Slimības simptomi, slodzes tolerance, hemodinamiskie rādītāji ir tikai aisberga redzamā daļa no kopējās PAH radītās negatīvās ietekmes uz pacienta dzīvi, aktualizējot starpdisciplināras un kompleksas ārstēšanas pieejas nepieciešamību. Pacientu ar PAH ārstēšanā nepieciešams apvienot gan specializētas veselības aprūpes pakalpojumus, gan ilgtermiņa intervences, kas vērstas uz hroniskas slimības pārvaldības spējas uzlabošanu un dinamisku adaptāciju. Tas aktualizē nepieciešamību veidot kompleksas fizioterapijas intervences, kas mērķētas ne tikai uz fizisko funkciju uzlabošanu, bet arī uz slimības pašpārvaldes veicināšanu un veselīgu ikdienas ieradumu veidošanu. Šis ir Latvijā pirmais pētījums par starpdisciplināru pieeju pacientu ar PAH ārstēšanā, mērķa medikamentozo terapiju apvienojot ar kompleksu, ikdienā iekļautu un attālināti pārraudzītu fizioterapijas programmu. Turklāt pētījumā izmantotā pieeja pacientu ar PAH dzīves kvalitātes izvērtēšanā, ietverot pašvērtējumu par izjusto iespēju piedalīties savā ikdienas dzīvē kontekstā ar veselības stāvokli, līdz šim nav bijusi aktualizēta, tādējādi paverot iespējas plašāk izgaismot pacienta perspektīvu par dzīvi ar retu, dzīvību apdraudošu un hronisku slimību. Mērķis. Izpētīt ikdienā integrētas, attālināti pārraudzītas fizioterapijas programmas efektivitāti starpdisciplināras ārstēšanas pieejā, lai uzlabotu un saglabātu pacientu ar PAH izjusto iespēju piedalīties savā ikdienas dzīvē, saistībā ar veselības stāvokli, paaugstinot fizisko funkciju rādītājus, izjusto pašefektivitāti, kā arī pilnveidojot fizisko aktivitāšu ieradumus un miega kvalitāti. Materiāli un metodes. Šis bija kontrolēts nejaušināts pētījums ar prospektīvu datu vākšanu laika periodā no 2020. gada februāra līdz 2020. gada septembrim, kurā tika analizēta izveidotā 12 nedēļu garā kompleksā fizioterapijas programma, kas ietvēra četrus pamatelementu: fiziskos vingrojumus; relaksācijas metodes; paškontroli un pašpārvaldi; izglītošanu un pārraudzību. Programma tika realizēta mājas vidē, integrēta pacienta ikdienas dzīvē un attālināti pārraudzīta. Dalībnieku izlase tika izveidota no Latvijas Pulmonālās hipertensijas reģistrā esošajiem pacientiem, balstoties uz definētajiem iekļaušanas kritērijiem. Izveidotā izlase tika nejaušināti sadalīta terapijas (n = 11) un kontroles grupā (n = 10) (turpmāk TG un KG). Abām grupām tika turpināta medikamentozā terapija, bet TG dalībniekiem papildus tika pievienota izveidotā fizioterapijas programma. Dalībnieku novērtēšana tika veikta trīs reizes – sākotnēji, pēc 12 nedēļām un atkārtoti (24 nedēļas kopš sākuma). Primārais rezultātu mērījums bija izjustās autonomijas un līdzdalības ierobežojuma izvērtējums ar IPA anketu, savukārt sekundārie rezultātu mērījumi ietvēra fizisko funkciju novērtējumu: 6 minūšu iešanas testā (6MIT) noietais attālums un desaturācija; ieelpas muskuļu spēks (cm H2O); izjustās pašefektivitātes izvērtējums ar GSE anketu; ikdienas fizisko aktivitāšu novērtējums ar akselerometriju; miega kvalitātes pašvērtējums (PSQI). Matemātiskās statistikas metožu izvēle tika veikta, ievērojot pakāpienu principu, vadoties pēc ieteikumiem mazo izlašu pētījumiem. Datu analīze veikta statistiskās nozīmības līmenī p < 0,05, savukārt atkārtotajiem mērījumiem tika piemērota Bonferroni korekcija (p < 0,025). Lai noteiktu efekta lielumu, tika aprēķināts Cohen’s d vai Glass rank biserial coefficient (rg), un statistiski nozīmīgiem rezultātiem post hoc analīzē tika noteikta statistiskā jauda, pieņemot, ka jauda vismaz 80 % (1- β ≥ 0,8) ir piemērota β kļūdas kontrolei. Rezultāti. Atkārtotajā novērtējumā tika vērota statistiski nozīmīga atšķirība starp grupām trijās IPA apakšskalās: autonomija ārpus mājas (p = 0,01, rg = 0,66, 1-β = 0,95), loma ģimenē (p = 0,04, rg = 0,55, 1-β = 0,8), autonomija mājās (p = 0,04, rg = 0,51, 1-β = 0,68), norādot uz lielākiem izjustās līdzdalības ierobežojumiem KG dalībniekiem, salīdzinot ar TG dalībniekiem. IPA summārajā rezultātā tika konstatēts statistiski nozīmīgs izjusto ierobežojumu samazinājums tikai TG gan pēc 12 nedēļām (vidēji par 4,4 % (TI 1,6–7,1)), gan atkārtotajā novērtējumā (vidēji par 5,8 % (TI 2,3–9,2)). Tikai TG novēroja statistiski nozīmīgu 6MIT noietā attāluma uzlabojumu: pēc 12 nedēļām vidēji par 51,8 m (TI 25,7–77,9; p < 0,001; d = 1,7), bet atkārtotajā novērtējumā vidēji par 75,5 m (TI 46,1–104,8; p < 0,001; d = 2,1), liecinot par klīniski nozīmīgu uzlabojumu. Kā arī tikai TG novēroja statistiski nozīmīgu ieelpas muskuļu spēka pieaugumu gan pēc 12 nedēļām – vidēji par 9,8 cm H2O (TI 6,9–12,7; p < 0,001; d = 2,2) –, gan atkārtotajā novērtējumā – vidēji par 10,5 cm H2O (TI 7,6–13,5; p < 0,001; d = 2,4). Statistiski nozīmīgu GSE pieaugumu konstatēja tikai TG pēc 12 nedēļām – vidēji par 9,4 % (TI 3,7–15,0; p = 0,004; d = 1,04). Akselerometrijas rezultāti uzrādīja nozīmīgu mazkustīgi pavadītā laika samazinājumu abās grupās, savukārt nozīmīgu zemas un vidējas intensitātes aktivitāšu pieaugumu tikai TG. Vienlaikus TG novērtējumā pēc 12 nedēļām tika vērota statistiski nozīmīga miega kvalitātes uzlabošanās (p = 0,013, rc = 0,76). Secinājumi. Kopumā pētījumā iegūtie rezultāti apliecina, ka pētītā fizioterapijas programma, kas tika realizēta starpdisciplināras ārstēšanas pieejā, aizkavē pacientu ar PAH izjustās līdzdalības pasliktināšanos ikdienas dzīves aktivitātēs, kā arī veido resursu, lai pacients ar PAH varētu uzlabot savas iespējas piedalīties ikdienas dzīves aktivitātēs tādā veidā, kā vēlas, neņemot vērā PAH un tās ārstēšanas ilgtermiņa ietekmi.