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The superiority of mitral E point-ventricular septum separation to other echocardiographic indicators of left
Insights
Mitral E point-ventricular septum separation (EPSS) measured by M-mode echocardiography strongly correlates with angiocardiographic ejection fraction. This method aids in assessing left ventricular performance, particularly in patients with coronary heart disease.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Coronary heart disease and congestive cardiomyopathy can impair left ventricular (LV) function.
- Accurate assessment of LV ejection fraction is crucial for diagnosis and management.
Purpose of the Study:
- To evaluate the correlation between mitral E point-ventricular septum separation (EPSS) and angiocardiographic ejection fraction.
- To assess the utility of EPSS in identifying impaired LV performance.
Main Methods:
- M-mode echocardiography, angiocardiography, and coronary arteriography were performed on 66 patients.
- Mitral E point-ventricular septum separation (EPSS) was measured using a modified method.
- Correlations were calculated between EPSS and various echocardiographic and angiocardiographic parameters.
Main Results:
- EPSS showed a strong correlation with angiocardiographic ejection fraction (r = 0.83).
- Patients with ejection fractions below 55% typically had EPSS values > 10 mm.
- LV dilatation, particularly of the outflow tract, was identified as a key factor in elevated EPSS.
Conclusions:
- The modified EPSS measurement is a reliable indicator of LV ejection fraction.
- EPSS is a valuable tool for assessing cardiac function in patients with suspected or known heart disease.
- LV dilatation plays a significant role in elevated EPSS values, suggesting its importance in assessing cardiac performance.
Abstract:
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 advantages.