Echocardiographic Examination:
Images were obtained via Philips iE33 (Philips
Medical Systems, Andover, MA, USA) with 2 and
2.5 MHz sector transducer equipped with TDI
mode while the patient in the left lateral decubitus
position. All measurements were taken on
three consecutive beats and the mean values were
used. No measurements were taken within five
cycles of an ectopic beat.
LV diameters and wall thickness were measured
according to criteria provided by the ASE.10
LVEF was calculated using Simpson’s rule. Three
RV dimensions were taken in the apical four chamber
view at end diastole:10 basal RV measurement
(RVD1) at the level of tricuspid annulus; mid RV
measurement (RVD2) at the level of RV papillary
muscles; and base-to-apex measurement (RVD3).
Pulmonary artery systolic pressure (PASP) was
calculated as: 4 × (peak tricuspid regurge velocity)2
+ right atrial pressure.11 Right atrial pressure
was estimated from the diameter and respiratory
motion of inferior vena cava in the subcostal
view.12 Pulmonary hypertension was defined as
a value of PASP > 35 mmHg. Mean pulmonary
artery pressure (MPAP) in mm Hg was calculated
according to the equation: MPAP = 80 – (RV out-
flow acceleration time/2).13,14 RV outflow tract
acceleration time was measured as the time interval
between the beginning of the pulmonary
flow and its peak velocity with the pulsed-wave
Doppler sample volume positioned in the region
of the pulmonary valve annulus.