Echocardiographic data acquisition
We performed a conventional transthoracic echocardiogram with subjects in lateral decubitus using a Siemens Acuson 2000 (Germany) with a phased array transducer that provided M-mode, color and tissue Doppler, with two and three-dimensional capabilities and software for atrial and ventricular mechanics following current guide-lines (11). Briefly, two-dimensional data were acquired from the parasternal long-axis and short axis views and three standard apical views. We recorded three consecutive cardiac cycles during expiration and obtained in a frame sequence of 50 to 80 frames per second. Left ventricular end-diastolic and end-systolic diameters (LVEDd; LVESd), interventricular septal thickness (IVST) and posterior wall thickness (PWT) were measured in the parasternal long axis view. Left ventricular ejection fraction (LVEF) was calculated based on the apical 4- and 2-chamber views, using the modified Simpson‘s biplane method or by 3D. LVEF was considered normal when it was ≥52% for men and ≥54% for women. Pulsed-wave Doppler of mitral valve inflow was used to measure the mitral peak early (E) and late (A) velocities and the ratio of early-to-late (E/A) diastolic flow velocities in the apical four chamber view, with the sample volume between mitral leaflet tips. Diastolic dysfunction was classified as: Grade I diastolic dysfunction (E/A<0.8, deceleration time >200 ms), impaired relaxation, Grade II  (E/A >0.8 -1.5, deceleration time: 160-200 ms), pseudonormalization, Grade III, restrictive filling (E/A >2.0, deceleration time <160 ms). The septal early diastolic myocardial velocity e´ and the ratio between early transmitral flow velocity E and e´ (E/e´ ratio) was measured in the four chamber view by pulsed Doppler and tissue Doppler, and the normal value was <14. (Figure 1) . Left atrial (LA) volume was assessed in the apical four chamber view at end-systole and was indexed to the BSA. The upper normal limit for LA volume index was 34 mL/m2 for both genders.
Left ventricular mass was calculated from the formula: 0.80*(1.04*[LVEDd + PWd + IVSd)3 − ( LVEDd)3] + 0.6 gr (11). Left ventricular mass (LVM) was indexed to BSA in gr/m2. LV hypertrophy was identified when the derived LVMI was ≥115 g/m2 for men and ≥95 g/m2 for women (11). The relative wall thickness (RWT) was calculated as (2 x PW thickness)/LV internal diameter at end-diastole. The RWT permits categorization of an increase in LV mass as either concentric (RWT > 0.42) or eccentric (RWT < 0.42) hypertrophy and makes it possible to identify concentric remodeling (normal LV mass with increased RWT >0.42) (11). The subjects were divided into four ventricular geometric groups: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT) (11).
Left ventricular wall motion was assessed with the 16-segment model. Each segment was evaluated in four, three and two-chamber views, and a four-grade score was applied: (1) normal or hyperkinetic, (2) hypokinetic (reduced thickening), (3) akinetic (absent or negligible thickening), and (4) dyskinetic (systolic thinning or stretching)