Commercially available instruments (Philips IE33 xMatrix, USA) equipped with 2.25 to 7.5 MHz imaging transducers were used; the subjects were in the left decubitus position, and an experienced sonographer was blinded to all the clinical details of the patients. The end-diastolic and end-systolic left ventricle diameters, interventricular septum thickness, and posterior wall thickness were measured from the parasternal long-axis view. LVEF was calculated from the apical four-chamber and two-chamber views using Simpson’s biplane method. Pulsed-wave Doppler of mitral, as well as tricuspid, inflow velocities, including early E and atrial A waves, were measured. Tissue Doppler imaging was used to measure averaged lateral and septal mitral annular systolic and early and late diastolic (Sm, E′, and A′) velocities, isovolumetric relaxation time, isovolumetric contraction time, and ejection time by placing a 1–2 mm sample volume in the septal and lateral mitral annulus, and these measurements were averaged. Pulmonary artery systolic pressure (PASP) was measured using the highest TR velocity recorded in any single view (PASP=4V2+estimated right atrial pressure).
Ie33 xmatrix
Manufactured by Philips
Sourced in United States
The IE33 xMATRIX is a diagnostic ultrasound system designed to provide advanced imaging capabilities. It features a robust and versatile architecture that supports a wide range of clinical applications.
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Lab products found in correlation
3 8 mhz sector ultrasound transducer, by Philips (2 mentions)
Intellispace cardiovascular ultrasound viewer, by Philips (2 mentions)
Epiq 7g, by Philips (2 mentions)
Qlab cardiovascular ultrasound quantification software, by Philips (1 mentions)
S5 1 transducer, by Philips (1 mentions)
X5 1 probe, by Philips (1 mentions)
Envisor c, by Philips (1 mentions)
4d rv function 2, by Tomtec (1 mentions)
26 protocols using ie33 xmatrix
1
Echocardiographic Assessment of Cardiac Function
2
IJV Cross-Sectional Area Measurement
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The left IJV was imaged by an experienced sonographer (Andrew Donald Robertson) at each level of each condition after at least 1 min of stabilization. The IJV was measured inferior to the midpoint along a direct line from the sternal notch to the mastoid process. A 5‐s cine loop was acquired of the vessel cross‐section using a 9–3 MHz linear array probe (iE33 xMatrix; Koninklijke Philips N.V.). Offline, individual frames were extracted from the exported video file (~23 fps, VLC Media Player; https://www.videolan.org/vlc/index.html ). The frame immediately following each ECG R‐spike was used for analysis, approximately corresponding with the c‐wave of the jugular venous pulse. The CSA was quantified semi‐automatically using the ellipse tool in ImageJ (https://imagej.nih.gov/ij/ ) and adjusted manually. The maximum CSA, across ~5 cardiac cycles, at each level of each condition was used for analysis to minimize variability due to respiration.
3
Carotid Artery Strain and Distensibility Evaluation
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An iE33 xMatrix and an Epiq 7G ultrasound machine (Philips, Amsterdam, The Netherlands) were used for examination. Both common carotid arteries (CCA) were recorded in short-axis view just below carotid bifurcation with a 3–8 MHz sector array transducer. During the entire examination period, study participants were in supine position, and the neck was extended to a 45° angle and turned to the opposite side of examination. Three consecutive loops were acquired under constant three-lead ECG tracking. Recorded clips were then transferred to a separate workstation (QLAB cardiovascular ultrasound quantification software, version 11.1, Philips, Amsterdam, The Netherlands). Peak circumferential strain (CS, %) and peak strain rate (SR, s−1) of both CCAs were measured semi-automatically through the software’s function “SAX-A”. The vascular region of interest was manually adjusted. Speckles of the vessel wall were then two-dimensionally tracked, as visualized in Figure 1 . A masked investigator analyzed the recorded loops three consecutive times, and an average was then calculated. Arterial distensibility (mmHg−1 × 10−3) was defined as
Data on ambulatory blood pressure, which were used for the calculation of arterial distensibility, were given in a recent publication by our department [10 (link)]. CS, SR, and arterial distensibility of the right and left CCA were averaged.
Data on ambulatory blood pressure, which were used for the calculation of arterial distensibility, were given in a recent publication by our department [10 (link)]. CS, SR, and arterial distensibility of the right and left CCA were averaged.
4
Echocardiography Evaluation of STEMI Patients
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Echocardiography (Philips iE 33 xMatrix) was performed on all STEMI patients 7–10 days after emergency PCI. According to the American Society of Echocardiography guidelines, the method of flow convergence (PISA) assesses the severity of mitral regurgitation (Zoghbi et al., 2003 (link)). As in our previous study, pulmonary artery pressure, left atrial dimension (LAD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end-diastolic diameter (LVEDD), left ventricular systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular end systolic volume (LVESV), and left ventricular end diastolic volume (LVEDV) were measured by echocardiography. The left ventricular mass (LVM) was calculated by the following formula: 0.8 × 1.04 × [(IVST + LVPWT + LVEDD) 3 − (LVEDD) 3] + 0.6 (Lang et al., 2015 (link)).
5
Echocardiographic Assessment of Cardiac Function
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Echocardiographic assessment was conducted by one investigator using a Philips iE33 xMatrix or a Philips Epiq 7G ultrasound device (Philips Healthcare, The Netherlands) with a 1–5 or a 3–8 MHz sector ultrasound transducer (Philips Healthcare, The Netherlands). Three consecutive loops were recorded under constant ECG-tracking and heart rate (bpm) was determined. Images were transferred to an offline workstation (IntelliSpace Cardiovascular Ultrasound Viewer, Philips Healthcare, The Netherlands) for analysis. Analysis for two-dimensional speckle tracking echocardiography (2DSTE) was conducted on a separate workstation (QLAB cardiovascular ultrasound quantification software, version 11.1, Philips Healthcare, The Netherlands). The offline assessment of LV systolic function was performed by one investigator for both groups.
6
Echocardiographic Assessment of Cardiac Structure and Function
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All patients underwent echocardiographic examination to assess the morphology and performance of the heart. We used a Philips model iE33 xMATRIX equipped with the S5-1 transducer. We evaluated the IVS thickness as well as the posterior wall thickness at end-diastole (normal range for male 0.6–1 cm and for female 0.6–0.9 cm) and the end-diastolic left ventricular (LV) dimension in M-mode and in parasternal long axis (normal range 42–58.4 mm for male and 37.8–52.2 mm for female). The following parameters were assessed: LV mass index and the relative wall thickness, the presence of concentric or eccentric hypertrophy and the presence of diastolic dysfunction. In addition, we evaluated the end-systolic and diastolic volume (63–150 mL and 21–61 mL for males, 46–106 mL and 14–42 mL for females), using Simpson’s biplane method to estimate the ejection fraction (normal range 52–72% for male and 54–74% for female) [18 (link)].
7
Echocardiographic Assessment of Cardiac Function
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All patients underwent a comprehensive transthoracic echocardiogram using a Vivid 7 or Vivid S6 ultrasound system (GE Vingmed Healthcare, GE Medical system, Milwaukee, USA) or iE33 X‐matrix (Philips, Eindhoven, the Netherlands). Left ventricular (LV) end‐diastolic and end‐systolic volumes and EF were measured as recommended.13 Pulsed‐wave peak early (E) and atrial (A) LV filling velocities, E/A ratio, and E‐wave deceleration time were also measured. Pulsed‐wave tissue Doppler imaging was used to detect lateral and septal mitral annular early diastolic velocities (E′), which were averaged. The ratio of early transmitral flow velocity (E wave) to the tissue Doppler imaging mitral annular averaged E′ velocity (E/E′) was then calculated. Right ventricular function was assessed by measuring tricuspid annular plane systolic excursion (TAPSE). Systolic pulmonary arterial pressure (SPAP) was estimated by combining the tricuspid regurgitation jet velocity with an estimate of right atrial pressure based on diameter and collapsibility of the inferior vena cava. The ratio between TAPSE and SPAP was then calculated.14 Severity of mitral regurgitation (Grades I–IV) was determined by measuring the effective regurgitant orifice area or vena contracta width, as suggested.15
8
Echocardiographic Assessment of Epicardial Fat
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The M-mode, two-dimensional, and Doppler echocardiographic examinations were
obtained by an ultrasound machine (Philips iE 33 xMatrix) to assess left atrial
(LA) diameter, interventricular septum (IVS) thickness, left ventricular
posterior wall (LVPW) thickness, left ventricular end diastolic diameter
(LVEDD), left ventricular end systolic diameter (LVESD), and left ventricular
EF. LA and left ventricular dimensions and left ventricular EF were measured by
M-mode echocardiography in the parasternal long axis view by using the American
Echocardiography Society M-mode technique[8 (link)]. The presence of mitral and aortic
insufficiency was evaluated by Doppler color flow mapping. EFT was identified
echocardiographically as the echo-free space between the outer wall of the
myocardium and the visceral layer of pericardium. EFT was measured at the point
on the free wall of the right ventricle along the midline of the ultrasound
beam, perpendicular to the aortic annulus at the end of
systole[4 (link)] (Figure 1 ).
As Iacobellis et al.[4 (link)] suggested, epicardial fat is best measured at
end-systole, because it is compressed during diastole. The average value of
three cardiac cycles was determined as EFT.
![]()
obtained by an ultrasound machine (Philips iE 33 xMatrix) to assess left atrial
(LA) diameter, interventricular septum (IVS) thickness, left ventricular
posterior wall (LVPW) thickness, left ventricular end diastolic diameter
(LVEDD), left ventricular end systolic diameter (LVESD), and left ventricular
EF. LA and left ventricular dimensions and left ventricular EF were measured by
M-mode echocardiography in the parasternal long axis view by using the American
Echocardiography Society M-mode technique[8 (link)]. The presence of mitral and aortic
insufficiency was evaluated by Doppler color flow mapping. EFT was identified
echocardiographically as the echo-free space between the outer wall of the
myocardium and the visceral layer of pericardium. EFT was measured at the point
on the free wall of the right ventricle along the midline of the ultrasound
beam, perpendicular to the aortic annulus at the end of
systole[4 (link)] (
As Iacobellis et al.[4 (link)] suggested, epicardial fat is best measured at
end-systole, because it is compressed during diastole. The average value of
three cardiac cycles was determined as EFT.
Measurement of epicardial fat thickness by echocardiography.
9
Carotid Artery Ultrasound Imaging Protocol
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A high-resolution B-mode ultrasound unit (iE33 xMATRIX, Philips Healthcare, Bothell, WA, USA) with a 7.5-MHz transducer was used to examine both carotid arteries in transverse and longitudinal sections. Ultrasound imaging methods have been previously described [4 (link),5 (link),6 (link),7 (link)]. Intima media thickness in a common carotid artery (cc-IMT) and carotid plaque thickness measurements were performed according to the Mannheim consensus [8 (link)]. In specific, cc-IMT was measured over the last 10 mm of the distal wall of both common carotids at a region without plaque. The highest value of ccIMT for both carotid arteries was assigned as ccIMTmax. Similarly, plaque thickness was measured in each detectable plaque. An experienced sonographer (G.B.) performed all ultrasound measurements.
10
Echocardiographic Assessment of Cardiac Function
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The 2D echocardiography was carried out by experienced operators using an ultrasound machine (Philips iE33 xMATRIX). The percentage of LVEDD and LVEF percentage were determined at the parasternal long-axis and short-axis views. All protocols were carried out following the recommendations by the American Society of Echocardiography and the European Association of Echocardiography [15 (link)].
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