Epiq 7c system

In the medical examination, the presence of ischemic heart disease, arterial hypertension, and diabetes mellitus was accurately recorded; moreover, cardiovascular drugs taken, weight, height, and systolic and diastolic arterial pressure were recorded. Heart rhythm and heart rate were assessed using a 12-lead electrocardiogram. History of chronic heart failure (CHF) was defined based on the current European Society of Cardiology criteria [6 (link)].
Echocardiographic images were obtained using an echocardiography EPIQ 7C system (Philips, Amsterdam, Netherlands) equipped with a 5-MHz probe. Left and right systolic functions were assessed by measuring the left ventricular ejection fraction (LVEF) (Simpson rule) and the systolic peak of the tricuspid annular plane excursion [7 (link)]. Mitral regurgitation (MR) and tricuspid regurgitation (TR) were semi-quantitatively evaluated using color Doppler, with arbitrary units ranging from 0 to 4. Dilatation of the inferior vena cava and its collapsibility during inspiration were evaluated to establish a central venous pressure (CVP) > 5 mmHg. Finally, pulmonary arterial systolic pressure (PASP) was evaluated based on the peak velocity of TR and estimation of the CVP [7 (link)].
Blood samples were taken to evaluate serum creatinine (mg/dL) and hemoglobin (g/dl) levels. The baseline GFR was calculated using the EPI formula [8 (link)].

The measurements were performed echocardiographically using the Philips Epiq 7c system. All the parameters were taken by a single person to avoid observer bias. The area of mitral valve was calculated using 2D planimetric method. Continuous-wave Doppler was used to measure the gradients across the mitral valve and pulmonary artery systolic pressure.
Post-BMV mitral valve area, pulmonary artery pressure, mean mitral gradient, and global LA strain were measured 24–48 h after procedure. Delta (Δ) was used to define the absolute changes in the valve area and gradients across the mitral valve pre- and post-BMV.
$$\begin{array}{l}\Delta \text{Mitral valve area}=\text{post}-\mathrm{BMV}\mathrm{MVA}\text{value}-\mathrm{pre}-\mathrm{BMV}\mathrm{MVA}\text{value}\\ \Delta \text{Mean mitral gradient}=\text{post}-\mathrm{BMV}\mathrm{MMG}\text{value}-\mathrm{pre}-\mathrm{BMV}\mathrm{MMG}\text{value}\end{array}$$

Echocardiography was performed in accordance with current guidelines, using two machines: between 2009 and 2019 a Philips iE33 system, equipped with a S5-1 transducer, and, since 2019, a Philips EPIQ 7C system (both Philips, Amsterdam, The Netherlands), equipped with a X5-1 transducer. Left ventricular wall thickness was measured on 2D B-mode end-diastolic images. Wall thickness was defined as the average of the septal and posterior wall thickness. For strain analysis, we used QLab 10.5 software, (Philips, Amsterdam, The Netherlands). For the analysis of the regional strain differences (to find the so called apical sparing or “cherry on top” sign), we followed the method originally described by Phelan et al. [7 (link)], and used the following equation: relative apical LS (longitudinal strain) = average apical LS/(average basal LS + average mid LS). All measurements were performed by a single experienced echocardiographer.