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Establishing Age-Specific and Sex-Specific Norms for Mitral Valve E-Point Septal Separation (EPSS) Measurements in

Jaya C Ruffin1, Christopher T Stem2, Scott Pletzer3

  • 1Department of Emergency Medicine, Prisma Health-Midlands, Columbia, SC.

Pediatric Emergency Care
|May 18, 2026
PubMed

Insights

This study established normal mitral valve E-point septal separation (EPSS) values for pediatric patients, finding lower measurements than in adults. These new pediatric EPSS references aid in diagnosing heart failure.

Area of Science:

  • Pediatric Cardiology
  • Echocardiography
  • Cardiac Physiology

Background:

  • Pediatric heart failure is rare but serious, necessitating accurate systolic function assessment.
  • Mitral valve E-point septal separation (EPSS) is a potential echocardiographic marker for systolic function.
  • Limited data exists on normal pediatric EPSS values, hindering clinical application.

Purpose of the Study:

  • To determine normal E-point septal separation (EPSS) values in a pediatric population.
  • To establish reference EPSS values for evaluating pediatric systolic function.
  • To investigate correlations between EPSS and pediatric patient characteristics.

Main Methods:

  • Retrospective analysis of 455 pediatric transthoracic echocardiograms (age ≤ 17).
  • Exclusion of patients with reduced ejection fraction or cardiac abnormalities.
  • Standardized EPSS measurement from parasternal long-axis views; inter-reviewer reliability assessed.

Main Results:

  • Median EPSS was 2.25 mm (IQR 2.06 mm) across all measurements.
  • Lowest 3 EPSS measurements per patient had a median of 1.33 mm (IQR 2.56 mm).
  • EPSS showed low-magnitude correlations with age, height, weight, body surface area, and ejection fraction.

Conclusions:

  • Observed pediatric EPSS values are lower than adult and previously reported pediatric values.
  • Potential differences in imaging and measurement techniques may account for variations.
  • Further prospective studies are needed to refine pediatric EPSS reference values and clinical significance.
Abstract

Keywords:
E-point septal separationEPSSechocardiogramheart failuremitral valve septal separationpediatricpoint-of-care ultrasound

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