Use of e-point septal separation to screen for left ventricular function in children

Area of Science:

• Pediatric Cardiology
• Echocardiography
• Point-of-Care Ultrasound

Background:

• E-point septal separation (EPSS) is a point-of-care ultrasound (POCUS) measurement for screening left ventricular systolic dysfunction (LVSD) in adults.
• Its utility and distribution in pediatric populations require further investigation.

Purpose of the Study:

• To evaluate the distribution of EPSS in children.
• To determine the association between EPSS and the presence and extent of LVSD in pediatric patients.
• To assess the diagnostic performance of EPSS thresholds for identifying LVSD.

Main Methods:

• Retrospective analysis of 770 pediatric echocardiograms (January 2019 - February 2023).
• LVSD classified as mild, moderate, or severe based on ejection fraction and/or fractional shortening.
• Evaluated EPSS association with LVSD and moderate-severe systolic dysfunction, reporting sensitivity and specificity for various thresholds.

Main Results:

• 148 of 770 echocardiograms showed LVSD (104 mild, 32 moderate, 12 severe).
• EPSS demonstrated a strong correlation with LVSD severity (AUROC 0.92 for any LVSD, 0.94 for moderate-severe LVSD).
• A 7.0 mm threshold showed 76.4% sensitivity and 95.8% specificity for any LVSD; a 6.0 mm threshold improved sensitivity to 81.8%. Age-specific thresholds (4.9 mm for 0-3 years) enhanced performance.

Conclusions:

• EPSS is a promising POCUS tool for screening pediatric LVSD.
• The 7.0 mm threshold is adequate for older children, while younger children may require a lower threshold (e.g., 4.9 mm) for optimal screening.