Mitral Valve E Point-Septal Separation as an Index of Left Ventricular Function with Valvular Heart Disease

Abstract

Echocardiographic mitral valve E point-septal separation (EPSS) has been found to be a useful hemodynamic index. Prior studies have shown a high negative correlation between EPSS and left ventricular ejection fraction (EF) in selected patients, but the utility of this index with valvular heart disease has not been examined in detail. Cardiac catheterization and M-mode echocardiographic data were retrospectively analyzed from 30 patients with aortic stenosis, 18 patients with chronic aortic regurgitation, and 25 patients with chronic mitral regurgitation. For aortic stenosis patients (including those with coronary artery disease), an excellent correlation (r = -0.89, p less than 0.001) was observed between EPSS and angiographic EF. More modest correlations were noted for patients with aortic regurgitation (r = -0.58, p less than 0.01) and mitral regurgitation (r = -0.63, p less than 0.001). For patients with aortic regurgitation, correlation improved to r = -0.83 by excluding subjects with marked (greater than 4 mm) fluttering of the anterior mitral valve leaflet. For patients with mitral regurgitation, the EPSS-EF correlation improved to r = -0.72 after excluding patients with atrial fibrillation. Compared with other echocardiographic indices of left ventricular function (percent shortening of the minor diameter or echo-derived EF), the EPSS demonstrated an equivalent or superior correlation with angiographic EF for each valvular lesion studied. We conclude that EPSS is a highly reliable index of left ventricular function with aortic stenosis, but its utility in unselected patients with chronic mitral or aortic regurgitation is limited.