Vivid s70

Follow‐up echocardiographic examinations were performed using the same strict protocol, personnel, and equipment (General Electric system, model Vivid S70). Routine LV echocardiographic parameters included LV diameters and LVEF.²⁰ Early transmitral flow velocity (E), late atrial contraction (A) velocity, and early diastolic mitral annular velocity (septal and lateral e′) were measured in the apical four‐chamber view to provide an estimate of LV diastolic function.²⁰ The peak E/peak e′ (E/e′) ratio was calculated (septal, lateral, and average mitral E/e′ ratio), and the deceleration time of the E wave was measured. The left atrium volume index was calculated using the biplane area length method at end‐systole. Images were acquired using a high frame rate (>50 frames/s),²¹ and thereafter stored digitally for offline analysis. LV GLS was measured using EchoPac STE software and tracking within an approximately 5 mm wide region of interest. An end‐systolic frame was used to initialize LV boundaries which were then automatically tracked throughout the cardiac cycle. Manual corrections were performed to optimize boundary tracking as needed. Optimization of images for endocardial visualization through adjustment of gain, compress, and time‐gain compensation controls were done before acquisition.

Transthoracic echocardiography was performed in all patients using a Vivid S70 ultrasound system (General Electric Healthcare, Chicago, IL, USA, 2018) after the end of the eight-week rehabilitation program. The cardiac parameters were assessed according to the current recommendations [17 (link)]. The findings were compared with the echocardiographic data obtained during hospitalization which was an indication for CR.

TTE was performed on all patients to assess right heart dysfunction using Vivid S70 (General Electric, Norway) based on the recommendations for the echocardiographic assessment of the right ventricle [17 (link)]. Right ventricle (RV)-focused apical four-chamber views were obtained. RV end-diastolic area (RV EDA) and RV end-systolic area (RV ESA) were measured. The RV fractional area change (FAC) was calculated as: (RV diastolic area − RV systolic area)/RV diastolic area × 100%. Tricuspid annular plane systolic excursion [18 (link)] was acquired with M-mode placed on the lateral wall of the tricuspid annulus in the apical four-chamber view. Systolic displacement was measured from end-diastole to end-systole. In addition, tissue Doppler imaging (TDI) was applied on the lateral side of the tricuspid annulus. RV myocardial performance index (MPI) was calculated as follows: (isovolumic contraction time + isovolumic relaxation time)/RV ejection time [19 (link)].

A standard comprehensive TTE was performed in each patient. The Vivid S70 and E9 (General Electric Medical Systems, Milwaukee, WI, USA) were used. Echocardiographic measurements were performed by qualified echocardiographers experienced in the quantitative assessment of valvular heart diseases.
According to the latest guidelines of the European Society of Cardiology (ESC) [2 (link)], severe AS was determined quantitatively on the basis of the aortic valve area < 1.0 cm², mean aortic gradient > 40 mmHg, or aortic jet velocity > 4.0 m/s.
TTE data were collected, including the left ventricular end-diastolic diameter (LVEDD), the LV end-systolic diameter (LVESD), the interventricular septum (IVS) diameter at the end-diastole, and the end-diastolic posterior wall thickness (PW), the left ventricle ejection fraction (LVEF). All measurements were made in the parasternal long axis view.

Initially, only TTE was mandatorily used to aid in pacemaker lead extraction, whereas TEE has been a standard tool over the last 6 years. TTE and TEE in our series were performed using Philips iE33 or GE Vivid S 70 machines equipped with X7-2t Live 3D or 6VT-D probes. All recordings were archived. Echocardiographic images were obtained before TLE, during the extraction procedure (continuous TEE monitoring) and after TLE to assess additional masses on the leads: scar tissue, vegetations, adhesions to the veins, cardiac walls and lead-to-lead binding as well as residual vegetation and scar tissue remnants (“ghosts”) after TLE.

A post-operative transthoracic echocardiographic (TTE) assessment was performed before hospital discharge: 2D TTE standard views were obtained using a standard ultrasound system using a 1–5 MHz probe (VIVID S70, GE Healthcare). A new TTE assessment was conducted at 1 year, using the same system. EOA was calculated by the continuity equation method. Aortic annulus diameter was measured at mid-systole, from the parasternal long-axis view, at the level of the prosthetic annulus, in a zoomed mode, from inner-edge to inner-edge. The velocity–time integral of blood flow was measured in the left ventricular outflow track by pulsed doppler. Mean transaortic gradient and maximal velocity were evaluated by transprosthetic continuous wave doppler. The doppler velocity index was calculated as the ratio of the proximal peak flow velocity in the LVOT to the transprothetic peak flow velocity. All examinations were interpreted blindly on a dedicated workstation (EchoPac 204 GE Healthcare) by two operators. In addition, during the follow-up, in case of bioprosthetic valve failure (BVF), a TEE and a cardiac CT were performed.

TEE was performed using the Philips iE33 or the GE Vivid S 70 ultrasound machine equipped with X7‐2t Live 3D or 6VT‐D probes. Images were obtained before the procedure, after general anesthesia and tracheal intubation, during preparation of the surgical field and dissection and stabilization of the leads in the device pocket. Leads were evaluated in the mid‐esophageal, inferior esophageal and modified transgastric views to visualize the right ventricle and the tricuspid valve. In order to obtain complete visualization of the structures (and assessment of lead/heart interaction) non‐standard imaging planes were sometimes required. After the procedure the results were entered into a computer database. We analyzed the number, location and course of the leads: in the superior vena cava (SVC), right atrium (RA), right ventricle (RV) (taking into account excess lead loops). We also assessed lead mobility, presence of sites at which the lead was bound to cardiac structures, lead‐to‐lead binding sites and additional masses attached to the leads. An important part of the imaging protocol was assessment of the effect of the lead on tricuspid function. Additionally, we assessed left ventricular function (LVEF), pericardial function and possible presence of structural heart disease (atrial or ventricular septal defects).