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[Significance of the E point-septum distance for the evaluation of left ventricular function in coronary disease--a
Insights
Mitral-septal separation effectively diagnoses reduced left ventricular (LV) ejection fraction (EF) in coronary artery disease patients. This echocardiographic measurement is reliable, especially for anterior wall infarctions, aiding in assessing global LV function.
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Context:
- Coronary artery disease (CAD) affects left ventricular (LV) function.
- Quantitative evaluation of LV cineangiograms is crucial for assessing global and regional function.
- Regional wall abnormalities are common in patients with CAD.
Purpose:
- To investigate the relationship between echocardiographic parameters and ventriculographic parameters in patients with CAD and regional wall abnormalities.
- To evaluate the diagnostic utility of mitral-septal separation for assessing reduced LV ejection fraction (EF).
Summary:
- Mitral-septal separation demonstrated the strongest correlation (r = -0.72) with angiographic ejection fraction (EF) among evaluated echocardiographic parameters.
- This measurement aids in diagnosing reduced EF independently of LV dilatation and is easily reproducible.
- Mitral-septal separation effectively differentiated between reference and infarction subgroups with reduced EF, showing higher sensitivity for anterior wall infarctions (0.73) than posterior (0.44).
Impact:
- Mitral-septal separation offers a reliable, non-invasive method for assessing global LV function in CAD patients.
- The study highlights the diagnostic value of mitral-septal separation, particularly its ability to detect reduced EF.
- Findings suggest that while useful, a pathologic mitral-septal separation is diagnostically definitive due to potential false negatives.
Abstract:
In 121 patients (pts) with angiographically proven coronary artery disease, left ventricular (LV) cineangiograms were quantitatively evaluated. 79 pts showed regional wall abnormalities. In this group the relationship between echocardiographic parameters of global (LV) function (mitral-septal separation, systolic and diastolic diameter, and fractional shortening) and ventriculographic parameters was investigated. Mitral-septal separation showed the best correlation to the angiographic ejection fraction (EF) (r = -0.72). The measurement of this parameter allows the diagnosis of a reduced EF independently of the dilatation of the left ventricle, and is easy to perform and to reproduce. Mitral-septal separation discriminated well between the reference group and all infarction subgroups (posterior wall, anterior wall, and double infarction) with reduced EF. The modification of the mitral-septal separation measurement according to D'Cruz et al. showed no advantage over that proposed by Massie et al. Both are clearly dependent upon septal excursion, which has to be taken into consideration when mitral-septal separation is being evaluated. The sensitivity of mitral-septal separation (greater than 7 mm) for the detection of reduced LV function (less than 55%) was 0.66; the specificity was 0.80. There was greater sensitivity for anterior wall infarctions than for posterior wall infarctions (0.73 vs 0.44). Because of the relatively high number of false negatives, only a pathologic mitral-septal separation is diagnostically useful.