Echocardiography
Transthoracic echocardiographic images were obtained using an ultrasound system, Vivid-7 (General Electric Vingmed), from the patients in the left lateral decubitus position, and these images were digitally kept for offline examination (EchoPAC version 110.0.0, GE-Vingmed). Echocardiographic acquisitions (colored, standard 2D, pulsed, and continuous-wave Doppler) were done. Standard M-mode images at a parasternal long-axis view were used to obtain the LV dimensions. Then, LV end-diastolic and end-systolic volumes were calculated using biplane Simpson’s method from the apical views (two- and four-chamber), and a correction was also performed for BSA. Following the aforementioned measurements, LVEF was calculated and the results were expressed with percentage. The biplane area-length method was used for the measurement of the LA volume (4).
All measurements and evaluations performed in the study were carried out considering the guidelines of the European Society of Echocardiography. Detailed examination of the aortic root, AV, and proximal ascending aorta was performed taking into account the standard guidelines. To evaluate the AR severity, comprehensive, color, continuous, and pulsed-wave Doppler recordings were carried out considering the recommendations that included the measurement of regurgitant jet width, vena contracta width, pressure half-time, and diastolic flow reversal in the descending aorta (5-7)
Aortic regurgitation severity was fixed on by two expert cardiologists who were working in the echocardiography laboratory with more than 5 years of experience. They used conventional echocardiographic evaluation methods for deciding severity degree if both of them were in the same decision on the severity degree of the patients in the study.