Speckle tracking echocardiography
Apical four and two-chamber, apical long-axis and parasternal short-axis images were acquired using conventional two-dimensional gray-scale echocardiography for speckle tracking evaluation on breath hold with a stable ECG recording and further Speckle tracking evaluation was performed by the same cardiologist. Three consecutive heartbeats were recorded and averaged. The frame rate was adjusted to between 90 and 120 frames per second. Automatic function imaging method was used for the assessment. The region of interest (ROI) was manually outlined by marking the endocardial borders at the mitral annulus level and at the apex on each digital loop. The epicardial surface was generated by the software (EchoPac, version 7.0.1 GE, USA) so that the ROI was created (Figure 2). The ROI was corrected manually at the end, if needed. After manual adjustments, ROI was divided into six segments and each segment was scored automatically by the software according to the image quality. Whether the tracking quality for each segment could be considered acceptable was determined by the software. The peak systolic strain values in a 17-segment LV model were used in the presented study. End- systole was defined as aortic valve closure in the apical long- axis view. The results for all three planes were then combined in a single bulls-eye summary that provided the global longitudinal strain