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)