CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 AFRICA 135 AVS was defined as calcification and thickening of a threeleaflet aortic valve with an aortic velocity of < 2 m/s. Patients with AF, aortic velocity ≥ 2 m/s, severe valvular heart disease, bicuspid aortic valve, estimated glomerular filtration rate (eGFR) ≤ 15 ml/ min, history of acute rheumatic fever, connective tissue disease and cancer were excluded. We analysed 411 patients with AVS grades 1–3 [AVS (+)] and 102 patients without AVS [AVS grade 0 AVS (–)]. The study protocol adhered to the ethical guidelines of the 2013 Declaration of Helsinki. This study was approved by the Ankara City Hospital Ethics Committee of the Ministry of Health Provincial Health Directorate (approval number E1-211638). We collected detailed information on gender, age, medical history, co-morbidities, results of routine blood laboratory test parameters and electrocardiographic data from the electronic medical reports of our hospital. The eGFR values were calculated by the modification of diet in renal disease (MDRD) equations. The CHA2DS2-VASc scores and diagnosis of all mentioned diseases of this score (CHF, HT, DM, stroke, vascular disease) were evaluated for each patient according to the current AF guideline of the European Society of Cardiology, published in 2020.11 All patients underwent TTE, performed by two experienced cardiologists who were unaware of the clinical status of the patients, using the Philips Affinity50 echocardiography device. The left ventricular posterior wall thickness (PWT), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), left atrial diameter (LAD) and ascending aortic diameter were measured on the parasternal long-axis view. The left ventricular ejection fractions (LVEF) of the patients were calculated using Simpson’s biplane method. We evaluated left ventricular diastolic dysfunction (LVDD) according to the update published by the American Society of Echocardiography and the European Association of CV Imaging.12 We assessed AVS from the parasternal long, parasternal short and apical five-chamber views. The presence of AVS was confirmed without using tissue harmonic imaging to avoid high gain settings.13 We defined AVS as focal areas of increased echogenicity and thickening of the leaflets without a restriction of motion, and peak velocity of less than 2.0 m/s. We graded the severity of AVS on a scale of 0 to 3: 0 = normal (no involvement), 1 = mild (minor involvement of one leaflet), 2 = moderate (minor involvement of two leaflets or extensive involvement of one leaflet) and 3 = severe (extensive involvement of two leaflets or involvement of all three leaflets) (Fig. 1).9 We defined AVS grade 0 as AVS (–) and AVS grades 1, 2 and 3 as AVS (+). Statistical analysis All data were analysed using the SPSS version 22.0 software (SPSS Inc, Chicago, IL). Continuous parametric data are Fig. 1. Echocardiographic images of AVS grades showing (A) normal, (B) mild, (C) moderate, (D) severe grades. A C B D
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