Image Recordings and Analysis
Standard echocardiographic measurements; EF with modified Simpson method, tissue doppler measurements, and cardiac valve evaluations performed with transthoracic echocardiography (EPIQ 7 echocardiography device (Philips, Amsterdam, Netherlands)) by two cardiologists. 2015 ASE (American Society of Echocardiography) guideline used as a reference for standard echocardiographic measurements (22). In echocardiographic tissue doppler evaluations, the myocardial performance index(MPI) is an index that incorporates both systolic and diastolic time intervals in expressing global systolic and diastolic ventricular function, also known as Tei Index, was also evaluated. MPI calculated with the formula ’[Isovolumetric contraction time(IVCT)+Isovolumetric relaxation time(IVRT)]/Ejection Time(ET)’, for both left ventricle lateral and septal parts (23).
Carotid systolic and diastolic diameters, intima-media thickness (IMT), and brachial flow-mediated dilatation performed with duplex ultrasound (Toshiba Sonolayer SSA 270 A equipped with a 7.5 Mhz linear array transducer, Toshiba Medical Systems, Japan). The carotid IMT measurements were performed in the distal 1 cm of each common carotid artery’s far wall and plaque-free segments. The mean carotid IMT value was derived from the measurements made in both carotid arteries’ locations (24). Two cardiologists perform all examinations and measurements.
All ultrasonic examinations were performed in a semi-dark room with continuous ECG. The brachial artery was evaluated by keeping the patient’s left arm still, in a horizontal plane, and a linear array transducer. Brachial artery diameters were assessed at the diastolic phase, approximately 2 cm above the elbow, in the longitudinal plane. Basal measurements were evaluated after 15 minutes of rest in the fasting state. The appropriate sphygmomanometer cuff located in the patient’s upper arm was then inflated to the level of 200 mmHg and waited for 4 minutes. Continuous recordings were made until 2 minutes after cuff deflation. The maximum rate of change was calculated considering the maximum measured diameter and resting brachial artery and the basal measurement. Peak flow-mediated dilatation of brachial artery (bFMD) measured in a percentage(%) and calculated with the formula ’[(maximum diameter - basal diameter)/basal diameter]*100’ (25,26).