Mitral-septal separation: New echocardiographic index of left ventricular function

Massie, Barry M.; Schiller, Nelson B.; Ratshin, Robert A.; Parmley, William W.

doi:10.1016/s0002-9149(77)80215-4

Cited by 141 publications

(57 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In previous publications (9,11), EPSS was measured as the vertical distance (on the stri p chart) between the nadir of the left septal echo and the subsequent E peak of the anterior mitral leaftlets (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

The superiority of mitral E point‐ventricular septum separation to other echocardiographic indicators of left ventricular performance

D’Cruz

Lalmalani

Sambasivan

et al. 1979

Clinical Cardiology

View full text Add to dashboard Cite

Summary: M-mode echocardiography, angiocardiography, and coronary arteriography were done in 40 patients with coronary heart disease, 12 with congestive cardiomyopathy, and 14 with no detectable cardiac or coronary abnormality. We measured mitral E point-ventricular septum separation (EPSS) at the moment of the E peak; the previously described method measures EPSS as the vertical distance between the nadir of systolic septal motion and the subsequent mitral E peak. Angiocardiographic ejection fractions correlated better with EPSS (r = 0.83) than with left ventricular (LV) end-diastolic internal diameter (r = 0.62), LV internal diameter systolic shortening fraction (r = 0.64), LV echocardiographic ejection fraction (r = 0.70), and LV posterior wall systolic thickening (r = 0.58). Patients with angiocardiographic ejection fractions below 55% usually had EPSS values over 10 mm by our method. Six false negatives and one false positive occurred. Our observations in patients with impaired LV performance suggest that LV dilatation, and especially dilatation of the LV outflow tract, is relatively more important than reduction in the amplitude of diastolic anterior mitral excursion in the production of high EPSS values. Although the usual method for measuring EPSS and ours are equally satisfactory, ours has certain theoretical ad~an tages.

show abstract

Section: Discussionmentioning

confidence: 99%

The superiority of mitral E point‐ventricular septum separation to other echocardiographic indicators of left ventricular performance

D’Cruz

Lalmalani

Sambasivan

et al. 1979

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…It is frequently used in veterinary medicine but is infrequently used in humans to detect poor systolic function despite positive reports of its accuracy. [10][11][12][13][14][15] A recent study by Secko et al 16 of point-of-care cardiac sonography of ED patients with dyspnea compared bedside E-point septal separation measurements performed by junior emergency medicine residents with visually estimated EF values by experienced emergency physicians. In the above-mentioned study, a significant correlation (-0.84; P < .001) was found between E-point septal separation and later visual estimations of the EF.…”

Section: Original Researchmentioning

confidence: 99%

E-Point Septal Separation Compared to Fractional Shortening Measurements of Systolic Function in Emergency Department Patients

Weekes

Reddy

Lewis

et al. 2012

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

Prospective Randomized Study edside emergency cardiac sonography is ideally suited to rule in or rule out poor left ventricular (LV) systolic function. 1 Overall cardiac function is important in making more accurate diagnoses and clinical care decisions. [1][2][3][4][5][6] Visual estimates of LV systolic function can differentiate severely depressed from normal LV systolic function, but physicians often encounter disagreements in differentiating moderately depressed and normal LV systolic function. [7][8][9] Quantitative comprehensive echocardiographic measAnthony J. Weekes, MD, Abhiram Reddy, MD, Margaret R. Lewis, MD, H. James Norton, PhD Received April 19, 2012, ORIGINAL RESEARCHObjectives-Rapid bedside assessment of left ventricular (LV) function can aid in the evaluation of the critically ill patient and guide clinical management. Our primary hypothesis was that mitral valve E-point septal separation measurements would correlate with contemporaneous fractional shortening measurements of LV systolic function when performed by emergency physicians. Our secondary hypothesis was that E-point septal separation as a continuous variable would predict fractional shortening using a linear regression model.Methods-We studied a prospective convenience sample of patients undergoing a sequence of LV systolic function measurements during a 3-month period at a suburban academic emergency department with a census of 114,000 patients. The sample included adult emergency department patients who were determined by the treating emergency physician to have 1 or more clinical indications for bedside LV systolic function assessment. Investigators performed bedside M-mode cardiac sonographic measurements of fractional shortening and E-point septal separation using the parasternal long-axis window. The sequence of LV systolic function measurements was randomized.Results-A total of 103 patients were enrolled. The Pearson correlation coefficient for E-point septal separation and fractional shortening measurements was -0.59 (P < .0001). Linear regression analysis performed for E-point septal separation with fractional shortening as the dependent variable yielded an R 2 value of 0.35.Conclusions-E-point septal separation and fractional shortening measurements had a moderate negative correlation. E-point septal separation, when used as a continuous variable in a linear regression model, did not reliably predict fractional shortening.

show abstract

“…Echocardiographic measurements were performed as recommended by the American Society of Echocardiography. 16 The mitral valve E-point to septal separation index was measured as reported by Massie et al 17 Measurements of right ventricular diastolic minor axis and right atrial systolic minor axis were performed as previously described.18 Measurements corrected for body surface area were compared with previously published normal values. '8,19 The upper limits of normal were as follows (cm/M2): left ventricular diastolic diameter, 3.2; left atrial systolic diameter, 2.3; right ventricular diastolic minor axis, 2.8; and right atrial systolic minor axis, 2.5.…”

Section: Patientsmentioning

confidence: 99%

Mildly dilated congestive cardiomyopathy. Use of prospective diagnostic criteria and description of the clinical course without heart transplantation.

et al. 1990

View full text Add to dashboard Cite

Prognosis in classically described dilated congestive cardiomyopathy has been reported to be related to ventricular size. Mildly dilated congestive cardiomyopathy (MDCM) has been defined as end-stage heart failure of unknown etiology (New York Heart Association class IV, left ventricular ejection fraction less than 30%), occurring with neither typical hemodynamic signs of restrictive myopathy nor significant ventricular dilatation (less than 15% above normal range). The present study includes follow-up in 12 nontransplant patients. In the first 4 months after diagnosis, two patients improved and are living, and two showed cardiac dilation and clinical deterioration and died. Six of the remaining eight with persistent MDCM died (four with intractable heart failure and two, sudden deaths) without change in ventricular size before death, despite medical therapy over 20±8 months. Eight comparable transplanted patients with persistent MDCM demonstrated improved total survival by life table analysis (p<0.05). A family history of congestive cardiomyopathy was found in nine of 16 patients (56%) with persistent MDCM. Nontransplant patients were older (p<0.02), but other findings were similar in the two groups. Endomyocardial biopsies available in 14 of 16 cases showed little or no myofibrillar loss in spite of severe hemodynamic impairment. The degree of myofibrillar loss did not correlate with hemodynamic parameters but showed good correlation with left ventricular size, that is, five of six patients with no myofibrillar loss had normal ventricular size, whereas all eight patients with mild myofibrillar loss had mild cardiomegaly (p<0.002).Our current experience suggests a somewhat variable but negative prognosis after prospective diagnosis of MDCM, with poor survival in patients with persistence of the original diagnostic features during follow-up. Preservation of heart size in MDCM is probably related to lack of significant myofibrillar loss. Thus, irrespective of heart size or myofibrillar preservation on biopsy, heart transplantation should be strongly considered in MDCM if signs of severe cardiac dysfunction persist despite therapy. (Circulation 1990;81:506-517) V entricular dilation is considered the earliest and most distinguishing morphologic feature of congestive cardiomyopathy, which is often called "dilated cardiomyopathy."1-5 Lack of significant ventricular dilation is typically found in hypertrophic and in restrictive cardiomyopathies.1,24-8 Restrictive cardiomyopathy has also been termed "nondilated cardiomyopathy" by some authors to emphasize its morphological appearance and differentiate it from dilated

show abstract

Mitral-septal separation: New echocardiographic index of left ventricular function

Cited by 141 publications

References 25 publications

The superiority of mitral E point‐ventricular septum separation to other echocardiographic indicators of left ventricular performance

The superiority of mitral E point‐ventricular septum separation to other echocardiographic indicators of left ventricular performance

E-Point Septal Separation Compared to Fractional Shortening Measurements of Systolic Function in Emergency Department Patients

Mildly dilated congestive cardiomyopathy. Use of prospective diagnostic criteria and description of the clinical course without heart transplantation.

Contact Info

Product

Resources

About