TTE evaluation
In this research, TTE was performed by two experienced
echocardiographers who were unaware of the patients’ medical data. For
all measurements, a Vivid S70N TTE device (GE-Vingmed-Ultrasound) and
M5Sc (1–5 MHz) ultrasound probe was applied. The biplane Simpson method
was used to measure the LV ejection fraction for each participant, while
the LV measurements were determined with using the M-mode method
obtained from the parasternal long-axis window. In order to record
either mitral or tricuspid flow velocities, the sample volume was
oriented at the tip of both valve leaflets in an apical 4-chamber window
by applying the pulsed Doppler method. From this window, the peak A
(atrial) flow velocity and the peak E (early) diastolic flow velocity
were recorded. To obtain the LV and RV tissue Doppler variables using
the pulsed wave Doppler method, the sample volume was oriented either on
the mitral lateral annulus or the tricuspid lateral annulus in the
apical 4‐chamber window. Both peak E’ (early diastolic) and peak A’
(late diastolic) cardiac velocities were recorded from this view. The RV
MPI (myocardial performance index) was obtained using the following
equation: tricuspid valve closure to opening time – RV-ET (ejection
time)/RV-ET. RV mid and annular diameters were obtained at the
end-diastole from the apical 4-chamber window. By accommodating a 2D
cursor at the tricuspid lateral annulus on the apical 4-chamber window,
the TAPSE (tricuspid annular plane excursion) was recorded for each
case. The simplified Bernoulli formula was performed to determine the
sPAP (systolic pulmonary artery pressure) (13).