Zabiela, Vytautas
Item type:Publication, research article[2026][S1][M001][11]; ; ; ; ; Medicina, 2026-04-22, vol. 62, no. 5, p. 1-11Background and Objectives: Cardiovascular disorders contribute substantially to medical ineligibility for compulsory military service in Lithuania. This study aimed to describe cardiovascular disease patterns and assess their association with military service eligibility among conscription-age individuals treated at a tertiary care center, considering gender, place of residence, age, and the most common cardiovascular causes of medical ineligibility. Materials and Methods: This retrospective hospital-based study included men and women aged 18–26 years with cardiovascular disease diagnoses defined according to ICD-10 codes specified by the Order of the Minister of National Defense of the Republic of Lithuania. Anonymized medical records from the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics were reviewed. Participants were categorized into four military service eligibility classes based on medical history data and were stratified by gender, age, and place of residence. Results: The study included 521 participants (56.6% male, 43.4% female). Gender and residence showed no significant impact on military service eligibility. Younger individuals, particularly those aged 18–19, were more often deemed eligible, while eligibility declined with age. Males more commonly had essential hypertension and hypertensive heart disease, whereas females more frequently presented with paroxysmal tachycardia and other arrhythmias. Hypertension and other severe cardiovascular conditions most strongly reduced eligibility for compulsory military service, whereas rhythm disorders were more often compatible with service. Conclusions: In this hospital-based cohort of conscription-age individuals with cardiovascular disease, gender and place of residence did not significantly influence eligibility for military service. Eligibility declined with increasing age, and hypertension-related cardiovascular disorders were the leading cause of ineligibility among conscripts.
65 10 Item type:Publication, conference output[2026][T1e][M001][2]Introduction Wolff–Parkinson–White (WPW) syndrome is a congenital cardiac conduction disorder caused by an accessory atrioventricular pathway, which increases the risk of serious tachyarrhythmias. Although often asymptomatic, WPW may present abruptly with severe symptoms. Rapid atrial arrhythmias conducted via the accessory pathway can induce excessively high ventricular rates, leading to hemodynamic instability or acute heart failure [1] even in young individuals without prior cardiac disease. Case Presentation A 33-year-old previously asymptomatic male presented to the Emergency Department with sudden palpitations, weakness, and presyncope after physical exertion. On admission, he was hemodynamically unstable, with a heart rate of 200–220 bpm and blood pressure of 90/60 mmHg. ECG revealed atrial fibrillation with wide QRS complexes, consistent with conduction through an accessory pathway. Vagal maneuvers and intravenous adenosine were ineffective; synchronized electrical cardioversion successfully restored sinus rhythm. Post-cardioversion ECG showed ventricular preexcitation with delta waves, confirming WPW syndrome. An electrophysiological study identified a left posterior accessory pathway with rapid anterograde conduction. Due to the life-threatening presentation, successful radiofrequency catheter ablation was performed without complications. Discussion WPW affects 0.1–0.3% of the population, peaking at 20–24 years, with 40–65% of adolescents and adults over 30 years remaining asymptomatic [1,2]. AVRT occurs in ~80% of symptomatic patients, while atrial fibrillation, though rare, may trigger pre-excited AF, ventricular fibrillation, and sudden cardiac death (SCD). AF prevalence is 11–40% and SCD risk is 3–4% in adults with WPW. Sympathetic activation during sport increases arrhythmic risk [2,3], highlighting the need for careful assessment in physically active individuals. Conclusions This case demonstrates that WPW can present with sudden, life-threatening arrhythmia during sport in previously healthy individuals. Male sex, age <35, history of AF or AVRT, multiple or septal accessory pathways, and rapid anterograde conduction increase SCD risk. Prompt ECG recognition, immediate cardioversion, and radiofrequency ablation, which is highly effective with low complication rates [1–3], are lifesaving.
3 17 Item type:Publication, research article[2026][S1][M001][11]; ; ; ; ; ; ; Cardiology Research, 2026-02-28, vol. 17, no. 1, p. 32-42Acute myocardial infarction (AMI) management has reduced in-hospital mortality, yet heart failure (HF) and atrial fibrillation (AF) remain common long-term complications. Left atrial (LA) function, assessed via speckle-tracking echocardiography (STE), provides sensitive markers of cardiac remodeling. This study aims to investigate the prognostic value of LA deformation parameters and their significance for long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI), particularly in relation to low triiodothyronine (T3) syndrome.
30 5 Item type:Publication, research article[2025][S1][M001][14]; ; ; ; Medicina, 2025-08-27, vol. 61, no. 9, p. 1-14Background and Objectives: Heart failure (HF) is a complex clinical syndrome with a high prevalence and significant morbidity. Classification of HF into preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) groups helps improve patient stratification and treatment. This study aimed to compare clinical, laboratory, echocardiographic, and electrocardiographic characteristics between different HF ejection fraction groups in a single-center patient cohort. Materials and Methods: A retrospective analysis of 1144 patients hospitalized with HF between 2022 and 2023 was performed. Patients were divided into three groups based on left ventricular ejection fraction. Results: HFrEF patients were predominantly male and younger, while HFpEF and HFmrEF groups had a higher proportion of older females. Atrial fibrillation and arterial hypertension were more common in HFpEF, while HFrEF patients showed more significant ventricular and atrial remodeling, lower tricuspid annular plane systolic excursion (TAPSE) values, and higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. No significant difference in in-hospital outcomes was found between HF groups. Conclusions: HF subtypes demonstrate distinct clinical and structural profiles, supporting the need for phenotype-based diagnostic and therapeutic approaches.
51 Item type:Publication, conference paper[2025][T1e][M001,N010][1]; ; ; ; ; ; ; ; ; ; ; Contemporary Pharmacy: Issues, Challenges and Expectations 2025 : April 10, 2025 : Abstract book, 2025-04-10, no. 2, p. 84-84Background: Familial hypercholesterolemia (FH) is an inherited disorder with a prevalence 1:250. FH is caused by variants in the genes coding low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB) and proprotein convertase subtilisin/kexin type 9 (PCSK9) [1,2]. It is crucial to identify patients with suspected FH and start treatment to prevent coronary artery disease (CAD). Aim: To compare FH patients antilipidemic treatment peculiarities. Methods: This is a retrospective cohort study of patients with a suspected FH. Subjects were included in the study according to the criteria of the Dutch Lipid Clinic (DLC), divided into three groups 1. patients with APOB variant; 2. patients with the LDLR variant. 3. patients without previously described variants. Next generation sequencing was used to sequence the coding regions. Statistical analysis was performed using SPSS 29.0.1. Results: A total of 45 patients were enrolled - 27 (60%) men and 18 (40%) women, mean age
- 47.93 years (SD=9.391). After genetic sequencing, 5 (11%) patients were diagnosed with APOB rs5742904, 2 (4%) patients had an LDLR rs879254754 variant. 35 (77%) subjects were using antilipidemic drugs (Chart 1). Most prescribed medications- high intensity dosage atorvastatin. 5 APOB rs5742904 variant patients vs. 1 LDLR rs879254754 variant patient were using antilipidemic drugs with a men LDL Cholesterol (LDL-C) 5,894 (SD=0,805) vs. 6,6 (SD=0,651) mmol/l. Patients with positive FH variant, had lower triglycerides (TGC) rate (1,82 vs. 3,26 mmol/l, p<0,02). Conclusion: According to our study, only three quarters of patients are treated based on recent European Society of Cardiology guidelines.
40 Item type:Publication, conference paper[2025][P1f][M001][7]; Kardiologijos praktika : Kauno krašto kardiologų draugijos konferencija "2024 m. EKD PV valdymo gairės: Pateikė daugiau aiškumo ar sumaišties?" : 2025 kovo 18 d. : Konferencijos pranešimų tezės/straipsniai, 2025-04-01, no. 2, p. 18-24SIMPTOMŲ MAŽINIMAS KOREGUOJANT RITMĄ IR DAŽNĮ (R) Pacientams, kuriems diagnozuotas prieširdžių virpėjimas (PV), reikalingas medikamentinis ir (ar) intervencinis gydymas širdies susitraukimų dažniui (ŠSD) kontroliuoti, sinusiniam ritmui (SR) grąžinti ir palaikyti, norint sumažinti simptomų pasireiškimą ir pagerinti ligos prognozę. Nors dažnai kalbama, kad reikia rinktis tarp ŠSD ar ritmo kontrolės, iš tikrųjų daugumai pacientų derėtų skirti sudėtinį gydymą ir vertinti jį paciento stebėjimo metu. Taikant į pacientą orientuotą gydymo modelį, ritmo kontrolė turėtų būti atliekama visiems PV sergantiems pacientams ir aiškiai apibrėžiama galima gydymo nauda ir rizika.
8 Item type:Publication, conference paper[2025][T1e][M001][2]; ; ; International Health Sciences Conference IHSC : Abstract book 2025 : [March 13 - 14, 2025, Kaunas] / Edited by Karina Zerr, 2025-03-13, p. 214-215Introduction Leadless pacemakers (LP) represent an established alternative to traditional transvenous permanent pacemakers (TV-PPM) in the management of brady-arrhythmias [1]. The primary indication for LP implantation over conventional pacemaker is due to a higher risk of device-related infections. The procedure has a high success rate and a low risk of major complications [2]. Since 2018, Kaunas Clinics has been the only medical institution in Lithuania performing this procedure. However, there is no data in the scientific literature regarding the population and indications for which LP implantation was performed. Aim To assess the demographics and clinical data for LP implantation in the Lithuanian population over the past seven years. Methods A retrospective analysis was conducted using the computerized medical data of all patients who received LP implantation at the Hospital of the Lithuanian University of Health Sciences (LUHS) Kaunas Clinics between January 1, 2018, and December 22, 2024. The study was approved by the Bioethics Centre of LUHS (2024-BEC2-1217). Results The research involved 18 individuals who received the Medtronic Micra™ model MC1VR01 LP. There were 10 females (55.6%) and 8 males (44.4%). The number of LP implantations per year was: 3 – 2018, 2 – 2019, 1 – 2020, 4 – 2021, 2 – 2022, 6 – 2023, and 0 – 2024. Eleven patients (61.1%) – 6 females and 5 males – are alive, with a median (IQR) age of 80 years (73–90). Seven patients (38.9%) – 4 females and 3 males – died for reasons unrelated to LP implantation (1–4 years after implantation), with a median (IQR) age of 86 years (80–92). The median (IQR) age at the time of LP implantation was 80.5 years (72.5–80.5). The median (IQR) BMI was 26.8 kg/m2 (23.2–30.9). The indications for pacemaker implantation were as follows: 50.0% for bradyarrhythmia with atrial fibrillation (AF), 38.9% for atrioventricular block, and 11.1% for sinus node dysfunction. The indications for LP were as follows: 33.3% for left- and right-sided TV-PPM pocket infection and explantation, 33.3% for left-sided, 27.8% as the first choice, and 5.6% for left- and right-sided subclavian vein occlusion. The median (IQR) procedural duration was 97.5 min (71.2–120.0). Early ventricular pacing threshold values were 0.65 V (0.52–0.80) at 0.24 ms, with an R wave on 12.8 mV (8.2–16.4), device longevity > 8 years. Conclusions Since the introduction of LP implantation in Lithuania, 18 devices have been implanted. The median age at Micra LP implantation was 80.5 years, while the median age at death was 86 years. The primary indication for Micra LP implantation was TV-PPM pocket infection, pacing system infection, or an increased risk of bacterial complications, while the main indication for stimulation was bradyarrhythmia with AF.
26 3 Item type:Publication, conference paper[2025][T1e][M001][3]; ; ; ; ; International Health Sciences Conference IHSC : Abstract book 2025 : [March 13 - 14, 2025, Kaunas] / Edited by Karina Zerr, 2025-03-13, p. 95-97Introduction Cardiovascular implantable electronic device (CIED)-related infective endocarditis (IE) presents significant challenges in both diagnosis and management [1]. The specific sign of infection is the presence of vegetations on the leads via echocardiography. Pulmonary embolism (PE) is a known complication in patients with CIED-related IE. This case report discusses the complex management of a patient with CIED-related IE who developed PE after lead extraction. Case Presentation A 76 years old patient was admitted to the Cardiology department with a suspected CIED-related IE, with vegetations observed on CIED leads in the right atrium and tricuspid valve, confirmed by transesophageal echocardiography (TEE). Patient was referred to the heart team. To reduce the risk of embolization prior and during device removal antibiotic therapy was initiated. Follow-up TEE showed a reduction of vegetations size so surgical extraction of implantable cardioverter-defibrillator leads and cardiac resynchronization therapy (CRT) system was performed and a temporary pacemaker was connected, due to the complete atrioventricular block as a bridge to permanent CRT reimplantation. Due to persistent dyspnea following the CIED extraction pulmonary scintigraphy was performed and PE was confirmed. Treatment for PE was initiated alongside ongoing IE management. Repeated transthoracic echocardiography showed signs of pulmonary hypertension. After two months patient was readmitted to the hospital for worsening heart failure attributed to unsynchronized stimulation from leadless pacemaker and CRT was implanted. Discussion CIED-related IE is a rare complication [2]. To treat it, it is strongly recommended to initiate antibiotic therapy alongside the complete removal of the device and all implanted leads [3]. While device and lead extraction are generally considered safe, the risk of PE remains substantial in IE cases, particularly in patients with vegetation exceeding 1 cm in size [4,5]. This complication poses a significant risk of further infectious complications and can induce a rapid increase in pulmonary pressures and acutely precipitate heart failure [4,6]. Conclusions Our case describes a CIED-related IE which was complicated by PE and progression of HF. While rare, situations like these occur and necessitate expertise in complex management.
7 5 Item type:Publication, journal-article[2025][S1][M001,N011][13]; ; ; ; ; ; ; ; ; ; ; ; ; ; ; International Journal of Molecular Sciences, 2025-03-06, vol. 26, no. 5, p. 1-13Hypercholesterolemia, characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C), along with inflammation, is a well-known risk factor for developing atherosclerosis and coronary artery disease (CAD). Many patients with hypercholesterolemia may carry inherited genetic variants that are not part of the commonly recognized mutations in the LDLR, APOB, LDLRAP1, and PCSK9 genes. These genetic variants may have cumulative effects that contribute to increased LDL-C levels and CAD development. The polygenic risk score (PRS) may provide an essential tool for evaluating an individual’s genetic predisposition to these conditions. This pilot study aimed to investigate the impact of the PRS calculated from specific single nucleotide polymorphisms (SNPs) associated with LDL cholesterol (LDL-C)—namely, CELSR2 rs629301, APOB rs1367117, ABCG8 rs6544713, LDLR rs6511720, APOE rs429358, and rs7412—on LDL-C levels in both healthy individuals with elevated LDL-C levels (>2.6 mmol/L) and those diagnosed with ST-segment elevation myocardial infarction (STEMI). A total of 61 healthy individuals with high LDL-C levels (>2.6 mmol/L) and 93 STEMI patients were selected for the study. The High-Resolution Melting Polymerase Chain Reaction (HRM PCR) method was adopted and sequencing techniques were employed to identify the specific single nucleotide polymorphisms (SNPs) of interest. The patient group exhibited a PRS of 0.824 (with a range of −0.62 to 1.174) compared to 0.674 (range: −0.176 to 0.974) in healthy individuals, indicating a higher genetic predisposition to elevated LDL-C levels (p = 0.001) in patients. Interestingly, patients had lower LDL-C concentrations than healthy individuals. Additionally, a more significant number of patients were past smokers and statin users. The PRS calculations revealed that patients with a higher PRS had increased odds of experiencing an MI, with an odds ratio of 12.044 (95% confidence interval: 1.551–93.517, p = 0.017). Similarly, smokers showed even higher odds, with an odds ratio of 24.962 (95% CI: 7.171–86.890, p < 0.001). Among healthy individuals, those with a higher PRS had increased odds of having an LDL-C concentration greater than 4.9 mmol/L (odds ratio: 20.391, 95% CI: 1.116–358.486, p = 0.039). However, no significant association was found between the PRS and LDL-C levels in the patient group during hospitalization (p = 0.782). This pilot study shows that PRS can be employed to evaluate the risk of MI and to estimate concentrations greater than 4.9 mmol/L LDL-C in healthy individuals.
54 24 Item type:Publication, journal article[2024][S6][M001][5]; Lietuvos gydytojo žurnalas, 2024-12-31, no. 10, p. 18-22Daugumos pacientų, kuriems diagnozuotas prieširdžių virpėjimas (PV), reikalingas medikamentinis ir (ar) intervencinis gydymas širdies susitraukimų dažniui (ŠSD) kontroliuoti, sinusiniam ritmui (SR) grąžinti ir palaikyti, kad būtų palengvinti simptomai ir pagerinta ligos prognozė. Nors dažnai kalbama apie tai, kad reikia rinktis valdyti arba ŠSD, arba ritmą, iš tikrųjų daugumai pacientų derėtų skirti sudėtinį gydymą, o tolesnio paciento stebėjimo metu jis turėtų būti vertinamas. Taikant į pacientą orientuotą gydymo modelį, ritmo kontrolė taikytina visiems tinkamiems PV sergantiems pacientams, aiškiai apibrėžiant galimą naudą ir riziką.
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