Mitral E point septal separation: a reliable index of left ventricular performance in coronary artery disease

The diagnostic value of E point septal separation (EPSS) was assessed in 108 patients with coronary artery disease who underwent coronary angiography and M-mode echocardiography within a 2-year period at LAC/USC Medical Center. In patients with anterior myocardial infarction, EPSS correlated well with angiographic ejection fraction, with a specificity of 85% and sensitivity of 82%. In inferior myocardial infarction, a 21% frequency of falsely elevated EPSS values was encountered; the sensitivity for detecting reduced ejection fraction was 100% and the specificity was 67%. In combined anterior and inferior myocardial infarction, EPSS accurately estimated abnormal ejection fractions with a sensitivity and specificity of 100%. An abnormal EPSS (more than 7 mm) was found to be more sensitive (87%) and specific (75%) in detecting individuals with angiographically reduced ejection fraction (less than 50%) compared to other echocardiographic indices of pump function. Importantly, EPSS was effective in estimating left ventricular function in the presence of left bundle branch block, paradoxical septal motion, and angiographic septal, posterior, and anterior wall motion abnormalities.