Transthoracic Echocardiography
TTE was performed at the day the patient presented to the cardiology clinic with Phillips EPIC CVx, Phillips Healthcare, Inc., Andover, MA, USA X5-1 matrix transducer. Left ventricular end-diastolic (LVD) and end-systolic (LVS) diameters, left ventricular posterior wall thickness (PW) and interventricular septum thickness (IVS) were measured from parasternal long axis view. Left atrium (LA), right atrium (RA) and right ventricular end-diastolic basal diameters (RV) were measured from the apical four-chamber view. Left ventricular ejection fraction (LVEF) was calculated with modified Simpson’s method from the apical four chamber view (15,16). The systolic pulmonary artery pressure (sPAP) was calculated from the sum of tricuspid regurgitation peak velocity and estimated RA pressure (16).
Speckle Tracking Echocardiography
LV apical 4-chamber, 2-chamber, and 3-chamber views which were stored during TTE in a frame rate of 60 to 100 frames per second (17) for images of 3 consecutive cardiac cycles were used for offline analysis. Imaging analysis was performed on the Phillips EPIC CVx’s QLAB software. The LV endocardial border of the end-systolic frame was automatically traced by the program and manually corrected if necessary. The software automatically created a region of interest including the entire transmural wall for all the patients and selected natural acoustic markers moving with the tissue. Automatic frame by-frame tracking of these markers during the cardiac cycle (2-dimensional [2D] systolic time interval method) yielded a measure of strain, and strain rate at any point of the myocardium. Left ventricular global longitudinal strain (LV-GLS) were measured by averaging the values of all segments.
The standard normal LV-GLS limit was defined as >-18% (18). The impaired GLS level was accepted as <-16%. The measurements between these levels were accepted as borderline (-18%) – (-16%) (19).
Statistical Analysis
The statistical analysis was performed with SPSS version 26. Categorical variables were represented as percentages while the numerical variables were determined as arithmetic mean ± standard deviation. Wilcoxon test was used for comparison of the averages of the data and Ki-square test was used for the comparison of the percentages of the data between groups. The significance levels of 0,05 and 0,001 values were considered for the study.
Results
Total of 55 patients were in the study group and divided into symptomatic (n:31) and asymptomatic (n:24) groups. Only the average age of the patients between the groups was statistically different and there was not a statistically significant difference between the other demographic and clinic features of the groups. The number of female patients were 27 (%49,09) in the study group. (Table 1)