Use of the Left Ventricular Internal Dimension at End-Diastole and the E-Point Septal Separation Ratio in the Prediction of the Left Ventricular Systolic Function in Patients with Midrange and Reduced Ejection Fractions: A Pilot Study
Background: The aim of this study was to investigate the ability of a new index, namely the left ventricular internal dimension at end-diastole/mitral valve E-point septal separation (LVIDd/EPSS), to predict the left ventricular (LV) systolic function and to compare its performance with that of the EPSS index and to investigate the correlation between the LVIDd/EPSS and the left ventricular ejection fraction (LVEF).
Methods: The current study recruited 142 patients who presented to the Cardiology Clinic of Sakarya University Education and Research Hospital and were followed for heart failure (HF).M-mode measurements of the EPSS and the LVIDd were recorded in the parasternal long-axis view.
Results: Totally, 142 HF patients with midrange ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) were enrolled in the study. There was a significantly correlation both between the EF and the EPSS and between the EF and the LVIDd/EPSS (P<0.001). In both HFmrEF and HFrEF groups, the correlation between the LVIDd/EPSS and the EF was more significant than was the correlation between the EPSS and the EF (P<0.001). The results of the linear regression analysis indicated that the LVIDd/EPSS was an independent predictor of the HFmrEF and the HFrEF (P<0.001). In the patients with EPSS≤12, there was a significant association between the EF and the LVIDd/EPSS (P<0.001) but not between the EF and the EPSS(P>0.05). The receiver operating characteristic curve analysis showed that the LVIDd/EPSS predicted advanced HF with 87% sensitivity and 72% specificity, using a cutoff value of 3.35,and it predicted the HFrEF (EF<40%) with 84% sensitivity and 81% specificity, using a cutoff value of 3.75.
Conclusion: The LVIDd/EPSS may allow certain clinicians, especially beginners and emergency department physicians, to assess the LVEF when other methods are not available or questionable.
Pershad J, Myers S, Plouman C, et al. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill subject. Pediatrics 2004;114:e667-71.
Randazzo MR, Snoey ER, Levitt MA, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med 2003;10:973–7.
Darbar D, Gillespie N, Byrd BF. Can visual echocardiography be used to select subjects for angiotensin-converting enzyme inhibitors following acute myocardial infarction? Eur Heart J 1996;17:1783–6.
Silverstein JR, Laffely NH, Rifkin RD. Quantitative estimation of left ventricular ejection fraction from mitral valve E-point to septal separation and comparison to magnetic resonance imaging. Am J Cardiol 2006;97:137–40.
Lew W, Henning H, Schelbert H, Karliner J. Assessment of mitral valve E point septal separation as an index of left ventricular performance in subjects with acute and previous myocardial infarction. Am J Cardiol 1978;41:836–45.
Massie BM, Schiller NB, Ratshin RA, Parmley WW. Mitral-septal separation: new echocardiographic index of left ventricular function. Am J Cardiol. 1977;39:1008–16.
Ahmadpuour H, Shah AA, Allen JW, Edmiston WA, Kim SJ, Haywood LJ. Mitral E point septal separation: a reliable index of left ventricular performance in coronary artery disease. Am Heart J. 1983;106(1 Pt 1):21–8.
Andersson B, Caidahl K, Waagstein F. An echocardiographic evaluation of patients with idiopathic heart failure. Chest 1995;107; 680:689–3.
Verma A, Meris A, Skali H, et al. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study. JACC Cardiovasc Imaging 2008;1:582–91.
Gardin JM, Wagenknecht LE, Anton-Culver H, et al. Relationship of cardiovascular risk factors to echocardiographic left ventricular mass in healthy young black and white adult men and women. The CARDIA study. Coronary Artery Risk Development in Young Adults. Circulation 1995;92:380–7.
Gaasch WH, Zile MR. Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry. J Am Coll Cardiol 2011;58:1733–40.
Ghali JK, Liao Y, Cooper RS. Ghali JK, Liao Y, Cooper RS. Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol 1998;31:1635.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1–39.
Cheitlin MD, Alpert JS, Armstrong WF, et al. ACC/AHA guidelines for the clinical application of echocardiography. Circulation 1997;95(6):1686–744.
Secko MA, Lazar JM, Salciccioli LA, Stone MB. Can junior emergency physicians use E-point septal separation to accurately estimate left ventricular function in acutely dyspneic patients? Acad Emerg Med 2011;18(11):1223–6.
Verdecchia P, Porcellati C, Reboldi G, et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation. 2001; 23;104(17):2039-44.
Chillo P, Lwakatare J, Lutale J, Gerdts E. Increased relative wall thickness is a marker of subclinical cardiac target-organ damage in African diabetic patients. Cardiovasc J Afr. 2012;23(8):435–41.
Copyright (c) 2019 The Journal of Tehran University Heart Center
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.