Echocardiography

In order to perform the transthoracic echocardiography, a Vivid 5 instrument with a 2.5 MHz transducer (GE Medical Systems, Milwaukee, WI, USA) was applied. American Society of Echocardiography recommendations were followed [13]. Interventricular septum thickness, (IVS), posterior wall thickness (PW), and systolic and diastolic diameters of the left ventricle (LV) were measured with M-mode echocardiography. The ejection fraction of the left ventricle was measured with the help of the Teichholz method [13]. The measurements of EFTt were carried out by a procedure suggested by Iacobellis et al. [14]. In accordance with the aforementioned procedure, the measurements were taken on the outer wall of the right ventricle. The EFT was discriminated by determining the echo-free space between the pericardium visceral lamina and external wall of the myocardium (Figure 6). Evaluations on M-mode strips were gathered from longitudinal cursor beam orientation in three cardiac cycles at the end-systole and end-diastole. At any side of the figures, the maximum values were measured and the derived values were averaged. The method that was utilised to determine the LV mass is Deveureux’s formula [15]. The formula is shown below: LV mass [g] = 0.8 × (1.04 × (((LVEDD + IVSd + PWd)³ – LVEDD³))) + 0.6, where LVEDD is LV end-diastolic diameter.

Measurement of epicardial fat tissue thickness (EFTt) by two-dimensional transthoracic echocardiography

Ao – aorta, LA – left atrium, RV – right ventricle, LV – left ventricle.

LV mass index (g/m²) was computed with help of the following formula [15]: LV mass index [g/m²] = left ventricular mass/BSA.

Respectively, LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) values were computed as follows [16]: LVEDV [ml] = (7/2.4 + LVEDD) × LVEDD³, LVESV [ml] = (7/2.4 + LVESD) × LVESD³.

LVEDV index (LVEDVI) was computed with help the of the following formula [15]: LVEDVI [ml/m²] = LVEDV/BSA.

EF (LV ejection fraction) and FS (fractional shortening) were evaluated with the help of the following formulas, respectively [16]: EF (%) = ((LVEDV – LVESV)/LVEDV) × 100, FS (%) = ((LVEDD – LVESD)/LVEDD) × 100.