2.3.1. Right-sided echocardiographic assessment:
The RV end-diastolic diameter (RVEDD) and the RV/LV ratio (RVLVr) were
used as indicators of RV dilation. RV systolic function was assessed by
the tricuspid annular plane systolic excursion (TAPSE) [28], and by
the tissue Doppler imaging (TDI) derived peak systolic annular velocity
at the tricuspid level of the RV free wall (St). RV Tei index (RVTX) was
used as a measurement of global (systolic and diastolic) RV function. It
was calculated using the TDI-derived isovolumic contraction (IVC),
isovolumic relaxation (IVR) and ejection time (ET) intervals (measured
at the lateral part of the tricuspid annulus) as previously
described[29]. RV systolic pressure was calculated by the systolic
gradient of the tricuspid regurgitation jet (TRJG) and using the
simplified Bernoulli equation [30]. Due to the absence of an
adequate tricuspid regurgitation jet in most patients, the RV outflow
tract acceleration time/ejection time ratio (ATET) [31], the LV
systolic eccentricity index (LVEI) [32], and the presence of septal
flattening at the end of systole on the qualitative assessment were also
used as indicators of RV systolic pressures [30]. The LVEI was also
used as a measurement of leftward displacement of the interventricular
septum (IVS).