Image Recordings and Analysis
Standard echocardiographic measurements; EF with modified Simpson
method, tissue doppler measurements, and cardiac valve evaluations
performed with transthoracic echocardiography (EPIQ 7 echocardiography
device (Philips, Amsterdam, Netherlands)) by two cardiologists. 2015 ASE
(American Society of Echocardiography) guideline used as a reference for
standard echocardiographic measurements (22). In echocardiographic
tissue doppler evaluations, the myocardial performance index(MPI) is an
index that incorporates both systolic and diastolic time intervals in
expressing global systolic and diastolic ventricular function, also
known as Tei Index, was also evaluated. MPI calculated with the formula
’[Isovolumetric contraction time(IVCT)+Isovolumetric relaxation
time(IVRT)]/Ejection Time(ET)’, for both left ventricle lateral and
septal parts (23).
Carotid systolic and diastolic diameters, intima-media thickness (IMT),
and brachial flow-mediated dilatation performed with duplex ultrasound
(Toshiba Sonolayer SSA 270 A equipped with a 7.5 Mhz linear array
transducer, Toshiba Medical Systems, Japan). The carotid IMT
measurements were performed in the distal 1 cm of each common carotid
artery’s far wall and plaque-free segments. The mean carotid IMT value
was derived from the measurements made in both carotid arteries’
locations (24). Two cardiologists perform all examinations and
measurements.
All ultrasonic examinations were performed in a semi-dark room with
continuous ECG. The brachial artery was evaluated by keeping the
patient’s left arm still, in a horizontal plane, and a linear array
transducer. Brachial artery diameters were assessed at the diastolic
phase, approximately 2 cm above the elbow, in the longitudinal plane.
Basal measurements were evaluated after 15 minutes of rest in the
fasting state. The appropriate sphygmomanometer cuff located in the
patient’s upper arm was then inflated to the level of 200 mmHg and
waited for 4 minutes. Continuous recordings were made until 2 minutes
after cuff deflation. The maximum rate of change was calculated
considering the maximum measured diameter and resting brachial artery
and the basal measurement. Peak flow-mediated dilatation of brachial
artery (bFMD) measured in a percentage(%) and calculated with the
formula ’[(maximum diameter - basal diameter)/basal diameter]*100’
(25,26).