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    Right bundle branch block as a marker for interatrial septal abnormalities
    (Cambridge University Press, 2012-02)
    Bakalli, A
    ;
    Kocinaj, D
    ;
    ;
    Bekteshi, T
    ;
    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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    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
    ;
    ;
    Kocinaj, D
    ;
    Musliu, N
    ;
    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.