Echocardiographic examination
Echocardiography was performed by using the Philips iE33 ultrasound system (Philips, The Netherlands) and a 5 Mhz transducer. Conventional echocardiography and STE were performed before and after treatment (4-6 weeks after-when acute phase reactants decrease). Systolic function was assessed by M-mode derived FS and EF. Left ventricular EF >54% and FS >28% were accepted as normal left ventricular systolic function [11].
For STE, two-dimensional four-chamber images together with short-axis mid-circumferential images of the left ventricle were obtained. Three cardiac cycles were recorded as cine loop clips. Strain and strain rate measurements were performed using the software package QLAB Advanced Quantification Software (version 6.0, Philips, The Netherlands). Main measures were left ventricular global longitudinal strain (LVGLS) and left ventricular global longitudinal strain rate (LVGLSR), left ventricular global circumferential strain (LVGCS) and left ventricular global circumferential strain rate (LVGCSR), right ventricular global longitudinal strain (RVGLS) and right ventricular global longitudinal strain rate (RVGLSR). All the images were obtained in the left lateral decubitus position under ECG monitoring. All echocardiographic parameters were analyzed by one researcher at two different time points.