Transthoracic echocardiography

Echocardiographic examinations were performed by an experienced cardiologist (G.A) who was licensed in Tukey, with Toshiba Aplio ultrasound system (TUS-A500, Shimoishigami, Japan) according to the American Echocardiography guideline [8]. Echocardiographic measurements were gained with all the participants in a left lateral decubitus position and left arm extended over the head. Transthoracic echocardiographic parameters including LVEF, interventricular septum (IVS) thickness, tricuspid regurgitation velocity (TRV), systolic pulmonary artery pressure (sPAP), diastolic dysfunction stages, grade of pericardial effusion (PE), left atrium (LA) diameter, right atrium (RA) diameter were obtained from the registry system for each patient. Pulmonary artery systolic pressure was measured using the Bernoulli equation with TRV and RA pressures. Right atrial pressures were calculated using the size of the inferior vena cava and the degree of collapsibility. Left ventricular ejection fraction was calculated using the Simpson method. Percardial effusion was diagnosed in the presence of an echo-free space between the visceral and the parietal pericardium. The classification was as follows: mild (5–10 mm), moderate/severe (> 10 mm). Left ventricular (LV) diastolic dysfunction was categorized into three stages. Stage I (mild diastolic dysfunction: E/A < 0.8, deceleration time > 200 ms, average E/e′ ≤ 8), stage II (moderate diastolic dysfunction or pseudonormal phase: E/A 0.8–1.5, deceleration time: 160–200 ms, average E/e′ 9–12), stage III (severe diastolic dysfunction: E/A ≥ 2, DT < 160 ms, average E/e′ ≥ 13).