Inclusion Criteria:  age from 18-85 years  Exclusion Criteria:  patients with history of myocardial infarction or abnormal wall motion suggested by conventional echocardiography patients with acute heart failure, chronic heart failure or LVEF values less than 50% patients with congenital heart disease, severe valvular disease, severe bradycardia, high atrioventricular block and atrial fibrillation patients who did not store ultrasound images or whose ultrasound images were unclear patients who had incomplete clinical data