Image Recordings and Analysis
Standard echocardiographic measurements; left ventricular ejection fraction(EF) with modified Simpson method, tissue Doppler measurements, and cardiac valve evaluations performed with transthoracic echocardiography (EPIQ 7 echocardiography device (Philips, Amsterdam, Netherlands)) with reference of 2015 ASE (American Society of Echocardiography) guideline (31). In echocardiographic tissue Doppler evaluations, global systolic and diastolic ventricular function indicator, the myocardial performance index(MPI), also known as Tei Index, is also calculated. The formula ’[Isovolumetric contraction time(IVCT)+Isovolumetric relaxation time(IVRT)]/Ejection Time(ET)’ is used for both left ventricle lateral and septal parts(32,33).
Carotid systolic and diastolic diameters, intima-media thickness (IMT), and bFMD performed with duplex ultrasound (Toshiba Sonolayer SSA 270 A equipped with a 7.5 Mhz linear array transducer, Toshiba Medical Systems, Japan). The distal 1 cm of each common carotid artery’s far wall and plaque-free segments were used for carotid IMT measurements. The mean carotid IMT value was derived from the measurements made in both carotid arteries’ locations (34).
All ultrasonic examinations were made with continuous electrocardiography (ECG), in a semi-dark room. Brachial artery measurements were made by keeping the patient’s left arm steady in a horizontal plane, approximately 2 cm above the elbow, in the longitudinal plane at the diastolic phase. Basal measurements were taken after 15 minutes of rest in the fasted state. The appropriate sphygmomanometer cuff located in the patient’s upper arm inflated to the level of 200 mmHg and waited for 5 minutes, and recordings will be continued until 2 minutes after cuff deflation. The maximum rate of change, which is also named as peak bFMD was calculated in a percentage(%) with the formula ’[(maximum diameter - basal diameter)/basal diameter]*100’ (35,36).