Transthoracic echocardiography including 2‐dimensional and Doppler type was performed in each patient using an E9 ultrasound system (GE Healthcare, Horten, Norway). Basal subaortic and midventricular gradients were measured with continuous‐wave Doppler in the apical 3‐chamber view. LV end‐diastolic diameter, LV ejection fraction, LV wall thickness, and left atrial diameter were quantified according to the recommendations of the American Society of Echocardiography.15 Rest LVOT obstruction was documented when a peak gradient ≥30 mm Hg in normal conditions was identified by Doppler.2 Mitral regurgitation was graded semiquantitatively and classified as mild, moderate, or severe.16 Pulmonary hypertension was defined as a pulmonary artery systolic pressure ≥35 mm Hg.
E9 ultrasound system
Manufactured by GE Healthcare
Sourced in Norway
The E9 ultrasound system is a diagnostic imaging device designed for general medical imaging applications. It utilizes ultrasound technology to create visual representations of internal body structures. The core function of the E9is to generate and display these ultrasound images for medical professionals to analyze and assess patient health.
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6 protocols using e9 ultrasound system
1
Comprehensive Echocardiographic Assessment of LVOT Obstruction
2
Transthoracic Echocardiographic Evaluation Techniques
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Transthoracic echocardiographic studies were performed using a commercially available system (E9 ultrasound system, GE Healthcare, Horten, Norway). With patients in the left lateral decubitus or supine position, complete M‐mode echocardiography, two‐dimension echocardiography, and Doppler studies were performed using standard parasternal, apical, and subcostal approaches. The diameters of the cardiac chambers were presented as the maximum value of the anteroposterior diameter in cardiac cycles. Maximum left ventricular (LV) wall thickness was the greatest dimension measured at any site within the LV chamber at end diastole. The LVOT gradient was scanned with continuous‐wave Doppler to measure maximal outflow velocity and estimated using the simplified Bernoulli equation. MVO refers to apposition of the mid‐ventricular walls during systole and often the papillary muscles with abnormally high‐velocities persisting through late systole and usually with early diastolic paradoxical jet flow.4
3
Preoperative Cardiac Assessment Protocol
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Venous blood samples were obtained during a patient’s first admission before cardiac surgery. The plasma was isolated after centrifugation, and the serum creatinine (sCr) and high-sensitivity C-reactive protein (hs-CRP) levels were measured. The patients’ preoperative eGFRs were calculated using the Modification of Diet in Renal Disease (MDRD) Study equation that has been adapted for the Chinese population as follows (16 (link)): eGFR (mL/min/1.73 m2) = 175 × sCr − 1.234 (mg/dL) × age − 0.179 (×0.79, if female).
Experienced physicians conducted the echocardiographic examinations using an E9 ultrasound system (General Electric Company, Boston, MA, USA). All patients underwent pre- and post-operative two-dimensional and Doppler echocardiography. The diameters of the cardiac chambers were recorded as the maximum anteroposterior diameters during the cardiac cycle. The thickness of the interventricular septum (IVS) was measured during diastole. The LVOTG was calculated using the simplified Bernoulli equation. The LV ejection fraction (LVEF) was measured according to the American Society of Echocardiography’s recommendations. The methods are described in more detail in our previous publication (17 (link)).
Experienced physicians conducted the echocardiographic examinations using an E9 ultrasound system (General Electric Company, Boston, MA, USA). All patients underwent pre- and post-operative two-dimensional and Doppler echocardiography. The diameters of the cardiac chambers were recorded as the maximum anteroposterior diameters during the cardiac cycle. The thickness of the interventricular septum (IVS) was measured during diastole. The LVOTG was calculated using the simplified Bernoulli equation. The LV ejection fraction (LVEF) was measured according to the American Society of Echocardiography’s recommendations. The methods are described in more detail in our previous publication (17 (link)).
4
Transthoracic Echocardiography Measurement Protocol
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TTE was performed using a commercially available system (E9 ultrasound system, GE Healthcare, Horten, Norway). Standard two-dimensional and Doppler echocardiographic images were acquired using a phased-array transducer in the parasternal and apical views and stored digitally for offline analysis using EchoPAC software version BT 113 (GE Healthcare, Horten, Norway). Each echocardiographic measurement was averaged from three consecutive cardiac cycles for patients in sinus rhythm and from five consecutive cycles in patients with atrial fibrillation. All measurements were performed according to the recommendations of the American Society of Echocardiography.[8 (link)]
5
Comprehensive Echocardiographic Assessment
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Doppler transthoracic echocardiogr aphy was performed using an E9 ultrasound system (GE Healthcare, Horten, Norway). Peak instantaneous left ventricular outflow tract or midventricular gradient was estimated using continuous wave Doppler echocardiography.
Two-dimensional measurements for left ventricular diastolic dimension, ventricular septum, posterior wall thickness, and left ventricular ejection fraction were assessed as recommended by American Society of Echocardiography before [15] (link). M-mode of left atrial enddiastolic dimension (LAD) was measured from the parasternal long-axis view. Left ventricular mass (LVM) was calculated in a standard fashion and was indexed to body surface area.
Two-dimensional measurements for left ventricular diastolic dimension, ventricular septum, posterior wall thickness, and left ventricular ejection fraction were assessed as recommended by American Society of Echocardiography before [15] (link). M-mode of left atrial enddiastolic dimension (LAD) was measured from the parasternal long-axis view. Left ventricular mass (LVM) was calculated in a standard fashion and was indexed to body surface area.
6
Echocardiographic Assessment of Hypertrophic Cardiomyopathy
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All patients (n ¼ 71) underwent TTE using an E9 ultrasound system (GE Healthcare, Horten, Norway).
Premyectomy, latest-review, and Dvalue between premyectomy and latest-review measurements were calculated, and the LVOT gradient was obtained using the simplified Bernoulli equation. Measurements of LV volume, LV ejection fraction, left atrial diameter, LV mass index, and wall thickness were determined following the American Society of Echocardiography recommendations [10] . The other methods of echocardiographic measurements are presented in Supplemental Method of echocardiographic measurements (references 1-3). A 17-segment model was used by the American Heart Association for myocardial segmentation on cardiac imaging [11] ; therefore LV free wall measurements included the following 11 segments (excluding the apical cap): anterior (basal, mid, and apical), anterolateral (basal, mid, and apical), inferolateral (basal and mid), and inferior (basal, mid, and apical). We measured each segmental thickness of LV free wall (previously mentioned 11 segments) in the end-diastolic cardiac cycle using echocardiography. The thickness of each segment was calculated and added together when the free wall thickness score was used.
Premyectomy, latest-review, and Dvalue between premyectomy and latest-review measurements were calculated, and the LVOT gradient was obtained using the simplified Bernoulli equation. Measurements of LV volume, LV ejection fraction, left atrial diameter, LV mass index, and wall thickness were determined following the American Society of Echocardiography recommendations [10] . The other methods of echocardiographic measurements are presented in Supplemental Method of echocardiographic measurements (references 1-3). A 17-segment model was used by the American Heart Association for myocardial segmentation on cardiac imaging [11] ; therefore LV free wall measurements included the following 11 segments (excluding the apical cap): anterior (basal, mid, and apical), anterolateral (basal, mid, and apical), inferolateral (basal and mid), and inferior (basal, mid, and apical). We measured each segmental thickness of LV free wall (previously mentioned 11 segments) in the end-diastolic cardiac cycle using echocardiography. The thickness of each segment was calculated and added together when the free wall thickness score was used.
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