Quantitative Estimation of Left Ventricular Ejection Fraction from Mitral Valve E-Point to Septal Separation and Comparison to Magnetic Resonance Imaging

Abstract

This study tested the hypothesis that the mitral valve E point-to-septal separation (EPSS) can be used to quantify the left ventricular (LV) ejection fraction (EF) on a continuous scale rather than simply as "normal" or "reduced." After excluding 5 patients with mitral valve prostheses, asymmetric septal hypertrophy, or significant aortic insufficiency, EPSS was measured in 42 patients by 3 independent observers on a cardiac magnetic resonance image identical to the echocardiographic parasternal long-axis view. In each patient, the reference standard LVEF was calculated from the magnetic resonance short-axis cross-sectional stack images by Simpson's rule and ranged from 11% to 72%. For all 42 patients, linear regression revealed the relation magnetic resonance imaging (MRI) LVEF = 75.5 - 2.5. EPSS (millimeters). Correlation between EPSS and the MRI LVEF for the 3 observers agreed closely, ranging from r = 0.78 to r = 0.82 (SEE 9 to 10), with similar regression coefficients. After blinded segmental wall motion scoring of the gated magnetic resonance cine images of the left ventricle in each patient, correlations, SEEs, and regression coefficients were found to be very similar in the 21 patients with the most homogenous wall motion, compared with the 21 patients with the most heterogenous wall motion. In conclusion, clinically useful quantitative prediction of the LVEF as a continuous variable can be obtained from the EPSS with a simple linear regression equation in a substantial portion of patients and may be a useful adjunct for assessment of LV function.