Echocardiographic Assessments and Outcome Measurements
Patients underwent transthoracic echocardiography using a Siemens ACUSON
SC2000 by an expert specialist of echocardiography. Measurements were in
accordance with the latest guideline of The American Society of
Echocardiography and the European Association of Cardiovascular Imaging9. All routine echocardiographic parameters in MS
patients were measured and calculated using standard parasternal and
apical windows. The planimetric method was utilized to measure MVA.
Additionally, RV size was evaluated by conventional apical four-chamber
view at end-diastole. RV systolic function was assessed by tricuspid
annular plane systolic excursion (TAPSE), fractional area change (FAC),
peak systolic velocity of the tricuspid annulus (S’) using TDI, and RV
free wall strain (RVFWS) by VVI software Syngo® Workplace. RV
longitudinal function was evaluated by TAPSE in M-mode echocardiography
with the cursor optimally aligned along the direction of the lateral
annulus of tricuspid valve in the apical four-chamber cardiac view. TDI
was employed to calculate S’, while taking caution to prevent velocity
underestimation by keeping the annulus and the basal segment aligned
with the Doppler cursor. FAC was assessed in RV-focused apical
four-chamber view, by determining the end-diastolic and end-systolic
area (100 × [End-diastolic area – End-systolic area] /
End-diastolic area). Recorded offline images were analyzed by Syngo®
Workplace software in order to measure strain. To guarantee that the
entire myocardial wall was included, endocardial and epicardial borders
of RV were traced and adjusted manually. The software automatically
traced and calculated the velocity of the tangential motion of the
speckles of the myocardium. RV free wall (RVFW) was defined as apical
lateral, mid lateral, and basal lateral segments; and RV free wall
strain (RVFWS) values were recorded and reported for each patient.
(Figure 1.)