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  • Author: Oskars Kalējs x
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Open access

Renate Dresmane, Laima Caunite, Aleksandrs Vasiljevs and Oskars Kalejs

Abstract

Background 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.

Open access

Kristaps Jurjāns, Santa Sabeļnikova, Evija Miglāne, Baiba Luriņa, Oskars Kalējs, Andrejs Millers and Zanda Priede

Abstract

Atrial 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, Rīga, 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.

Open access

Maija Vikmane, Oskars Kalējs, Ginta Kamzola, Dana Upīte, Madara Ventiņa, Nikolajs Ņesterovičs and Aivars Lejnieks

Abstract

The 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.

Open access

Aldis Strēlnieks, Alberts Bērziņš, Māra Karakone, Irina Pupkeviča, Kristīne Jubele, Maija Vikmane, Sandis Sakne, Oskars Kalējs and Aivars Lejnieks

Abstract

Patients 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 (Rīga, 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%.