Epic7g

Comprehensive transthoracic two-dimensional and Doppler echocardiographic examination were performed using a commercially available ultrasound system (iE33 or Epic7G, Philips Medical System, Andover, Massachusetts; Vivid E95, GE Healthcare, Horten, Norway).
3DE was performed according to guidelines of the American Society of Echocardiography (ASE) using an iE33, Epic7G, or Vivid E95 equipped with a 3DE transducer (X5-1, Philips Medical System, Andover, Massachusetts; 4V or 4Vc, GE Healthcare, Horten, Norway) (3 (link)). 3DE datasets that focused on the left heart chamber were acquired from the apical approach in one- or multi-beat acquisition mode. In addition, 3DE datasets that focused on the right heart chamber were acquired from more lateral transducer positions. In order to increase the volume rate, the width of the image sector size was reduced as narrow as possible, keeping orthogonal 2D echocardiographic images encompassing the entire right ventricle. Datasets were transferred to a separate workstation for off-line analysis.

Echocardiograms of patients with congenital and structural heart disease were selected retrospectively from the routine clinical imaging database of the Department of Cardiology III—Adult Congenital and Valvular Heart Disease at the University Hospital Muenster. Echocardiograms were chosen for diversity of underlying disease etiology (see Table 1), comprehensiveness of echocardiographic views and quality of acquired loops. In addition, echocardiograms of patients without a cardiac abnormality were prospectively included according to the aforementioned criteria. The examinations were performed on different echocardiography machines from different vendors (especially GE Vivid E9, Vivid E95, Vivid 7; Philips EPIC 7C, EPIC 7G, iE33). Two-dimensional (2D) echocardiographic studies performed according to current guideline recommendations [1 (link)] were anonymized, exported and converted into individual frames in a PNG format for automated analysis. In total, individual frames of 17 separate TTE views were obtained. Figure 1 details the utilized echocardiography views.

3DE was performed immediately after standard transthoracic 2D echocardiography (2DE) and Doppler echocardiography. 3DE images were acquired using an apical approach and commercially available ultrasound machines (iE33 or Epic7G, Philips Healthcare, Andover, MA; Vivid7 or Vivid E95, GE Healthcare, Horten, Norway) equipped with a 3DE transducer (X3-1 or X5-1, Philips Healthcare, Andover, MA; 4V, GE Healthcare, Horten, Norway). Trans-mitral flow velocity was recorded at the coaptation point of both leaflets. Mitral annular velocities were recorded at septal and lateral sides of the mitral annulus, and average e' was calculated. Peak aortic flow velocity was recorded in multiple transducer positions, and the highest value was used for the measurements of the mean pressure gradient (PG) and velocity-time integral (VTI). RV fractional area change (RVFAC) was calculated by standard formula. 2DE RV speckle tracking analysis was performed using commercially available, vendor-independent, fully automated strain analysis software (AutoStrain RV, TomTec Imaging Systems, Unterschleissheim, Germany). The software automatically determined the RV endocardial border and performed speckle tracking analysis during a single cardiac cycle. The endocardial border was manually corrected as required. RV free-wall longitudinal strain (RVfwLS) and global longitudinal strain (RVGLS) were calculated.