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

Abstract

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.

Estimation of Cardiac Systolic Function Based on Mitral Valve Movements: An Accurate Bedside Tool for Emergency Physicians in Dyspneic Patients

“…Three (P‐ALSS, EPSS, and A‐ALSS) of the 4 methods used to evaluate the relationship between the anterior mitral valve and the septum produced similar results (13.10 ± 7.34 mm, 13.26 ± 7.42 mm, and 13.33 ± 6.93 mm, respectively) and were highly correlated with EF ( r = −.84, −.83, and −.82, respectively). D'Cruz et al reported a similar correlation between EPSS and EF ( r = −.83) to our results. We encountered no previous studies evaluating the anterior mitral valve–septal distance from the apical axis.…”

“…To the best of our knowledge, this relationship between LVEF and mitral valve function has previously been investigated only on the parasternal long axis or EPSS. The EPSS method has also previously been shown to distinguish only between abnormally low and normal LVEF …”

Effects of sedation with acepromazine on echocardiographic measurements in eight healthy thoroughbred horses

“…The pre‐ejection period ( pep ) was measured as the time from the onset of the Q wave on the electrocardiogram to the onset of valvular opening, and the left ventricular ejection time ( lvet ) was measured as the time from the onset of the opening of the valve to its closure (Patteson and others 1995a). The E point to septal separation ( epss ) distance was measured from the M‐mode recordings of the right parasternal short‐axis views at the level of the mitral valve as the vertical distance between the nadir of systolic interventricular septal motion and the subsequent mitral valve E peak (D'Cruz and others 1979).…”

Usefulness of M-Mode Echocardiography in the Diagnosis of Heart Failure

“…Technically, Mmode échocardiographie measurement of EPSS is quite simple, but EPSS may be influenced by functional or structural abnor malities of the heart, such as atrial fibrilla tion. aortic insufficiency, mitral stenosis, or an aneurysm or local dysfunction of the in terventricular septum [24], In earlier studies examining the utility of EPSS as an indicator of LV systolic function, increased EPSS has been shown to be a specific but rather insen sitive indicator of low LV ejection fraction in patients with coronary heart disease [ 16,[19][20][21][22]. In the present study, a marked nega tive correlation was observed between EPSS and FS.…”

“…We are not aware of any other study designed to evaluate the utility of EPSS in the diagnosis of HF, although the relation of EPSS and LV systolic function has been studied extensively [16,[19][20][21][22][23]], Our results demonstrate that the measurement of EPSS is useful in the diagnostic evaluation of pa tients with suspected HF. Technically, Mmode échocardiographie measurement of EPSS is quite simple, but EPSS may be influenced by functional or structural abnor malities of the heart, such as atrial fibrilla tion.…”