Vivid e95

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.

Two-dimensional (2D) echocardiographic imaging consisting of AP4 cine loops with exactly three cardiac cycles were included. At our centre, these studies were obtained by certified sonographers and read by level III-trained echocardiography cardiologists on the same day. The echo cine data were captured using a variety of ultrasound machines from different manufacturers and models, including GE (Vivid i, Vivid E9, Vivid7, and Vivid E95; Milwaukee, WI, USA) and Philips (iE33, SONOS, EPIQ 7C; Bothell, WA, USA), with the majority of the data obtained from the Philips iE33 model. Syngo Dynamics (Siemens Medical Solutions, Ann Arbor, MI, USA) was the archiving and analysis platform for this study, and TomTec was used for strain analyses. The gold standard for cardiac rhythm was the echocardiography cardiologists’ interpretation of the ECG rhythm strip at the time of echocardiogram, in addition to imaging assessment of the full study including Doppler. The rhythm was additionally confirmed with an external 12-lead ECG, reviewed by a staff cardiologist, around the time of each echocardiography study to account for similar irregular rhythms that may be undifferentiable on the echocardiogram rhythm strip alone. When possible, two consecutive ECGs around the time of echocardiography were examined to acknowledge the possibility of paroxysmal AF.