Atrial Electromechanical Delay Measurement
TTE (EPIQ 7 Cardiology Ultrasound - Philips Ultrasound, Netherlands, using 3.5 MHz probe) was performed in the left lateral decubitus position by the same cardiologist the day before the surgical procedure. Standard measurements were made from parasternal long and short axis, and 2 and 4 chamber apical views. The measurements were made by considering the American Society of Echocardiography (ASE) Guideline (7).
The EF was calculated according to the modified biplane Simpson’s method (7). Mitral flow velocities were recorded from four chamber apical views with pulsed wave Doppler (PWD) with a 5-mm sample volume placed at the mitral valve tip levels. Peak early diastolic mitral velocity (E), and late diastolic mitral velocity (A) were recorded.
TDI is an echocardiographic technique that measures the velocities of cardiac structures. TDI records were made in four chamber apical views. The gain settings were minimized and TDI filter and Nyquist limits were set as 16-20 cm/s. Systolic mitral annular velocity (Sa), early diastolic mitral annular velocity (Ea) and late diastolic mitral annular velocity (Aa) values were recorded from lateral and medial mitral annulus and lateral tricuspid annulus. (Figure 1) Atrial late diastolic tissue Doppler velocity (Aaa) were recorded from left atrial (LA) and right atrial (RA) lateral wall and interatrial septum. (Figure 1). The time interval between the beginning of the P wave in the surface ECG and the beginning of Aa/Aaa record detected with TDI was called as AEMD’. Ventricular annular measurements were specified as lateral mitral annulus (left ventricle (LV) lateral AEMD), medial mitral annulus (LV medial AEMD) and lateral tricuspid annulus (right ventricle (RV) lateral AEMD). Atrial wall measurements were specified as lateral LA wall (LA lateral AEMD), inter-atrial septum (LA medial AEMD), and lateral right atrium (RA) wall (RA lateral AEMD).