Echocardiographic measurement Echocardiography examinations were

Echocardiographic measurement Echocardiography examinations were performed with a Vingmed new product System 5 Doppler echocardiographic unit. Conven tional echocardiography measurements were performed according to American Society of Echocardiography guidelines. LV mass was calculated using the Dev ereux formula. LVM was corrected for body surface area to obtain the LVM index. Left atrial diam eter and aortic root dimension were also measured. LV systolic function was assessed using LV ejec tion fraction. Diastolic function was assessed by determining the E to A ratio and deceleration time, where E and A represent the early and late ventricu lar filling velocities respectively. The diagnosis of SHF re quires the following criteria, Presence of signs and or symptoms of chronic HF, Presence of abnormal LV systolic function.

The definition of DHF was recommended by the European Society Cardiology guide lines in 2008. The diagnosis of DHF requires three conditions to be satisfied, presence of signs and or symptoms of chronic HF, presence of normal or only mildly abnormal LV systolic function, evi dence of diastolic dysfunction. Diastolic function of LV was evaluated on the basis of the ventricular filling pattern to detecting abnormalities of diastolic function or filling in patients with HF. Normal LV diastolic function was defined as E A ratio 1 and 160 ms DT 240 ms. LV diastolic dysfunc tion was defined as the following criteria, E A ratio 1 and DT 260 ms or E A ratio 2 and DT 150 ms. Data analysis Data were checked for normality and described as mean SD or median unless stated otherwise.

Kolmogorov Smirnov Test was used to determine whether continuous variables followed a normal distribution. Variables that were not normally distributed were log transformed to ap proximate normal distribution for analysis. The character istics of subjects according to SHF, DHF and control were assessed using the one way analysis of variance for continuous variables and the 2 test for categorical var iables. Univariate LR was performed to determine the variables associated with outcomes and to estimate con founding factors possibly disturbing the relationship be tween MetS and SHF or DHF. Univariate association between candidate predictors and the different outcome categories were estimated using multinomial LR analysis which allows for simultaneous estimation of the probabil ity of SHF and DHF compared with control as reference category.

The multinomial LR analysis includes several LR models simultaneous to estimate the associations between predictors and each of outcomes compared with reference category simultaneous so that regression coefficients may differ per outcome. Multivariable LR controlling for confounders was carried out to determine contribution inhibitor Rapamycin of independent variables to SHF or DHF.

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