Faculty of Medicine

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Right bundle branch block as a marker for interatrial septal abnormalities
(Cambridge University Press, 2012-02)
Bakalli, A
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Kocinaj, D
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Bekteshi, T
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Pilana, E
Background: Interatrial septal anomalies, which include atrial septal defect, patent foramen ovale, and atrial septal aneurysm, are common disorders among adult patients. Early detection of interatrial septal anomalies is important in order to prevent haemodynamic consequences and/or thromboembolic events. Electrocardiogram offers some clues that should serve as hints for detection of interatrial abnormalities. The aim of our study was to analyse the interatrial septum by transoesophageal echocardiography in patients with electrocardiogram signs of right bundle branch block and in those without right bundle branch block. Methods and results: In a prospective study, 87 adult patients were included, that is, 41 with electrocardiogram signs of right bundle branch block forming the first group and 46 without right bundle branch block forming the second group. Interatrial septal anomalies were present in 80.5% of the patients with right bundle branch block, with patent foramen ovale (39.02%) being the most prevalent disorder, followed by atrial septal aneurysm (21.9%) and atrial septal defect (19.5%). Interatrial septal abnormalities were significantly more frequent in the first group compared with the second group (80.5% versus 6.5%, p value less than 0.001). Independently, patent foramen ovale was significantly more prevalent in patients with right bundle branch block (39.02% versus 4.3%, p value less than 0.001), as were atrial septal aneurysm (21.9% versus 2.2%, p value equal 0.01) and atrial septal defect (19.5% versus 0%, p value equal 0.004). Conclusions: Right bundle branch block should serve as a valuable indicator to motivate a detailed search for interatrial septal abnormalities.
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Prevalence of Left Chamber Cardiac Thrombi in Patients with Dilated Left Ventricle at Sinus Rhythm: The Role of Transesophageal Echocardiography
(Wiley Online Library, 2013-01)
Bakalli, A
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Kocinaj, D
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Musliu, N
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Krasniqi, A
Background: Left atrial appendage (LAA) may be a source of thrombi in patients with dilated cardiomyopathy at sinus rhythm. The objectives of our study were to assess the prevalence of intracardiac left chamber thrombus and/or spontaneous echo contrast and to identify clinical and echocardiographic predictors for left ventricle (LV), left atrium (LA), and/or LAA thrombus formation, particularly as regard to LV, LA, and LAA size, in heart failure patients at sinus rhythm. Methods: We included 45 patients with dilated cardiomyopathy of ischemic or idiopathic origin with mild to moderate systolic dysfunction, who were at sinus rhythm and without anticoagulation therapy. Results: Mean left ventricular end diastolic diameter was 64.9 ± 6.1 mm, and mean LV ejection fraction was 39.9 ± 7.3%. LV thrombus was found in 13.3% of patients and LAA thrombus in 68. 9%. Left ventricular end diastolic diameter was correlated with LA volume (r = 0.59, p < 0.0001) and LV thrombus (r = 0.38, p = 0.005). LA volume was correlated with LAA maximal area (r = 0.34, p = 0.01), which was an independent predictor for LAA thrombus formation (p = 0.003). Conclusions: Dilation of left cardiac chambers offers a suitable terrain for thrombus formation. The high probability of LAA thrombosis should be kept in mind when designing the treatment strategy for patients with dilated cardiomyopathy at sinus rhythm.
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Relationship of Mitral Annular Plane Systolic Excursion (MAPSE) to Left Ventricular Thrombus Formation
(2014-10)
Bakalli, A
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Zahiti, B
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Hocinaj, D
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Gecaj-Gashi, A
Background: Dilated cardiomyopathy is associated by radial and longitudinal contractile cardiac dysfunction. Left ventricular (LV) thrombus is a frequent finding in patients with dilated cardiomyopathy. The main purpose of our study was to evaluate the role of mitral annular plane systolic excursion (MAPSE) in LV thrombus formation in patients with dilated cardiomyopathy by assessing their correlation. Our additional objective was to compare the relationship of average MAPSE to relations of other LV features [LV size, LV ejection fraction (EF), wall motion score index (WMSI), sphericity index-width to length ratio (w/l) of the LV] and LV thrombus developmentMaterial and Methods: This was a prospective cross-sectional study conducted from October 2009 until January 2012 in 100 sinus rhythm patients with dilated cardiomyopathy without anticoagulation therapy. We excluded patients with: swallowing problems, acute myocardial infarction, atrial fibrillation/flutter, severe systolic dysfunction, severe arterial hypertension, valvular disease, and/or mechanical valves. Results: Mean patient age was 58.1±12.7 years and 69% were men. Mean LV EF was 39.1±6.4%, while mean value of average MAPSE was 9.3±2.2mm. LV thrombus was detected in 14% of patients and its presence correlated well with: average MAPSE (r=-0.22, p=0.01), MAPSE of sepatal wall (r=-0.23, p=0.01), MAPSE of lateral wall (r=-0.2, p=0.02), MAPSE of inferior wall (r=-0.22, p=0.01), LV EF (r=-0.21, p=0.02), LV end diastolic diameter (r=0.24, p=0.008), LV end systolic diameter (r=0.31, p=0.0008), WMSI (r=0.22, p=0.01) and w/l (r=0.19, p=0.03). Conclusions: Longitudinal LV dysfunction is associated with LV thrombus formation, as average MAPSE demonstrates a negative correlation with LV thrombus, and its role is similar to LV size, LV EF, sphericity index and WMSI.
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Relationship of left ventricular size to left atrial and left atrial appendage size in sinus rhythm patients with dilated cardiomyopathy
(Academy of Medical Sciences of Bosnia and Herzegovina, 2012-06)
Bakalli, A
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Musliu, N
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Kocinaj, D
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Gashi, Z
Introduction: Thromboembolic events are a frequent cause of mortality in patients with congestive heart failure. The aim of or study was to evaluate the relationship of left ventricular end diastolic diameter (LVEDD) to left atrial (LA) size and left atrial appendage (LAA) size in patients with dilated cardiomyopathy in sinus rhythm, as well as to determine the prevalence of thrombi in LV and LA /LAA. Methods: This was a prospective cross-sectional study, conducted from December 2009 until December 2011. The study included 95 patients with dilated cardiomyopathy in sinus rhythm. Patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flatter, severe systolic dysfunction, and/or patients who were taking oral anticoagulation therapy were excluded. Results: Mean patient age was 58.6 ± 12.2 years and 68.4% were men. Mean LVEDD of our population was 66.5 ± 6.5 mm, while mean LA atrium, LA volume and LAA maximal area were 46 ± 5.1 mm, 87.2 ± 38.7 cm3 and 4.7 ± 1.2 cm2, respectively. LA diameter (p<0.001) and LAA maximal area (p=0.01) showed to be independent predictors of LV size. LV thrombus was detected in 13 (13.7%) patients, while LAA thrombus in 46 (48.4%) patients of our study population. Conclusions: In conclusion, dilated LV size is associated with enlarged LA and LAA size. On the other hand, dilation of LV, LA and LAA is related to high prevalence of left chamber cardiac thrombi.
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Lower Body Weight in Men, an Epidemiological Predictor of Enlarged Left Atrium in Sinus Rhythm Patients with Dilated Heart
(Wolters Kluwer - Medknow, 2016-07)
Bakalli, A
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Musliu, N
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Kocinaj, D
Background/Aims: The source of thrombi in patients with dilated cardiomyopathy is not necessarily from the dilated left ventricle. Left atrium (LA) and left atrial appendage (LAA) might be in charge for relatively high rate of systemic embolizations in these patients. The main aim of our study was to identify epidemiological predictors in sinus rhythm patients with dilated heart for LA and LAA dilation and/or dysfunction. Patients and Methods: This was a prospective cross-sectional study conducted from 2009 to 2014 in 101 sinus rhythm patients with dilated heart. We excluded patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flutter, severe systolic dysfunction, mechanical valves, oral anticoagulation therapy, and/or patients with a history of stroke/systemic thromboembolic event. Results: Mean patient age was 58.13 ± 12.66 years and 69.3% were men. Hypertension was encountered in 51% of our patients, 56% of them had a history of coronary artery disease, 30% had diabetes, 25% had dyslipidemia, 30% were smokers, whereas 10% were alcoholics. Mean LA dimensions resulted higher than reference values, whereas 86% of our patients had LAA dysfunction. Male gender was an independent predictor for LA diameter dilation (95% confidence interval [CI]: 1.765–9.078, P = 0.005), while lower body weight was a predictor for enlargement of LA area (95% CI: 0.044–0.351, P = 0.014) and LA volume (95% CI: 0.160–2.067, P = 0.024). Conclusion: Male patients with dilated cardiomyopathy at sinus rhythm with lower body weight tend to have larger LA and consequently might be at higher risk of developing atrial thrombus and its subsequent consequences.
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Left ventricular and left atrial thrombi in sinus rhythm patients with dilated ischemic cardiomyopathy
(Academy of Medical Sciences of Bosnia and Herzegovina, 2012-06)
Bakalli, A
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Kocinaj, D
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Musliu, N
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Zahiti, B
Introduction: Ischemic dilated cardiomyopathy offers a favorable terrain for left ventricular (LV) thrombus formation; however, left artial appendage (LAA) may be an additional source of thrombi in patients with dilated heart. The main objectives of this study were to determine the prevalence of LV and LAA thrombi in patients with chronic ischemic dilated cardiomyopathy in sinus rhythm, as well as to reveal echocardiographic predictors for thrombus formation. Methods: The study included 57 patients with chronic dilated ischemic cardiomyopathy in sinus rhythm, who were not under oral anticoagulation therapy. Exclusion criteria included patients with: swallowing problems, acute myocardial infarction, idiopathic and/or non-ischemic dilated cardiomyopathy, atrial fibrillation/flatter, severe systolic dysfunction. Transthoracic echocardiography and transesophageal echocardiography were obtained for each patient. Results: Mean patient age was 62 ± 10.5 years, mean LV end diastolic diameter was 67.2 ± 5.8 mm, whereas mean LV ejection fraction (EF) was 37.1 ± 4.3 %. LV thrombus was detected in 11 (19.3%) patients; while 23 (40.3%) patients had LAA thrombus. In a multiple regression analysis LV size (p=0.05) and lack of aspirin therapy (p=0.02) showed to be independent LV thrombus predictors, whereas lower LV EF (p=0.02) and larger LAA maximal area (p=0.004) demonstrated to be independent predictors of LAA thrombus. Conclusions: We consider that our study sheds light to the high possibility of LAA thrombi formation in addition to LV thrombi in patients with chronic dilated ischemic cardiomyopathy in sinus rhythm. LV size, LV EF, LAA maximal area and lack of aspirin therapy are shown to be independent predictors of left heart chamber thrombi in this patient category.

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