CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 176 AFRICA and Internal Medicine Departments to the echocardiography laboratory of the Cardiology Department of Bolu Abant Izzet Baysal University. The study excluded patients with organic valvular heart disease, coronary artery disease or atrial fibrillation. Active haematemesis was also considered an exclusion criterion. Detailed medical histories were collected in each instance under consideration, emphasising a comprehensive history of liver cirrhosis, including its genesis and progression. All patients underwent a thorough physical examination, emphasising clubbing, ascites, spider nevi, lower limb oedema, palmer erythema and liver/spleen examinations. All patients had a 12-lead resting ECG to assess velocity, rhythm, aberrant findings and arrhythmias. A complete blood count, serum liver function tests including aspartate aminotransferase (AST) and alanine aminotransferase (ALT), serum albumin and serum bilirubin levels, prothrombin time and international normalised ratio were performed on all patients. The Child–Pugh score categorises liver cirrhosis into A, B or C categories based on bilirubin and albumin levels, prothrombin time and encephalopathy severity.19 Pulse oximetry measurements recorded at rest in both the supine and upright postures were used to approximate peripheral capillary oxygen saturation (SpO2). Arterial blood samples were drawn in the supine position and the partial pressures of oxygen (pO2) and carbon dioxide (pCO2) were used to calculate the age-adjusted alveolar–arterial oxygen gradient (AaPO2). An AaPO2 value greater than 15 mmHg in patients under 65 years and greater than 20 mmHg in patients over 65 years was considered evidence of an oxygenation impairment. The GE-Vingmed Vivid 7 System (GE-Vingmed Ultrasound, Horten, Norway) with an M3S (3.5-MHz) matrix probe and echo Pac version 8.0 GE Healthcare was used for transthoracic echocardiography. After images were collected from the parasternal and apical windows, the parameters below were acquired. Three cardiac cycles were observed towards the end of the exhale phase. All data were transmitted to a workstation for offline analysis (EchoPAC PC; GE Vingmed Ultrasound AS). Traditional two-dimensional (2D) echocardiographic examinations were performed by the techniques indicated in an American Society of Echocardiography guideline.20 We measured the dimensions of the left atrium and left ventricle. Simpson’s biplane approach calculated the left ventricular ejection fraction (LVEF).21 The RV fractional area change (FAC) was calculated by dividing the percentage area change in the apical four-chamber picture at end-systole and end-diastole by two. TAPSE was computed by measuring the systolic displacement of the M-mode longitudinally crossing the tricuspid annular plane and parallel to the lateral wall of the right ventricle. Pulsed-wave Doppler imaging of the mitral inflow profile was used to measure the ventricular filling velocities in the early (E) and late (A) waves and the E/A ratio was calculated.22 The myocardial systolic (St), early diastolic (E′), and late diastolic (A′) velocities were all measured using a tissue Doppler imaging sample volume positioned at the septal and lateral mitral annuli. Fig. 1. A: Measurement of St. B: measurement of PAMVUT. LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract. A B
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