Faculty of Medicine

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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
    ;
    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 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
    ;
    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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    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.