{"id":1820,"date":"2020-10-14T08:00:00","date_gmt":"2020-10-14T08:00:00","guid":{"rendered":"https:\/\/emultrasound.sdsc.edu\/?p=1820"},"modified":"2021-05-04T16:57:04","modified_gmt":"2021-05-04T16:57:04","slug":"epss-echo-2","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/10\/14\/epss-echo-2\/","title":{"rendered":"How accurate is EPSS in estimating ejection fraction?"},"content":{"rendered":"
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Background<\/h2>\n

Bedside echocardiography has an established role in the time-sensitive assessment for pericardial effusion, relative chamber size, and global cardiac function of emergency department (ED) patients. Most ED physicians use visual estimation to gauge left ventricular ejection fraction (LVEF), a method that may be subject to inter-observer variability and inaccuracy (1). E-point septal separation (EPSS), the minimum separation between the anterior mitral valve leaflet and the interventricular septum, may offer a more objective measure of LVEF.<\/p>\n

\"epss<\/p>\n

EPSS was first studied in the 1970s as a quantitative, easily measured, and reproducible index of left ventricular function (2). In healthy individuals, the mitral valve leaflet reaches its maximum excursion near or at the septum during early diastole. EPSS increases as left ventricular ejection fraction (LVEF) decreases, and an EPSS of greater than 7mm predicts poor LVEF (3,4).<\/p>\n

The gold standard for evaluating LVEF is a quantitative, calculated value obtained from comprehensive transthoracic echocardiography, which is impractical in the emergency department, thus EPSS offers a simple to learn and easy to obtain alternative, requiring only one view in the parasternal long axis. EPSS measurement is a technique feasible for the ED physician to perform at the bedside that can provide a convenient and reliable estimate of LVEF. <\/p>\n

 <\/p>\n

E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n

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Clinical Question<\/h3>
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Does EPSS measurements obtained by ED physicians correlate with calculated LVEF from comprehensive transthoracic echocardiography (TTE)?<\/span><\/p>\n

Can certain EPSS cutoff values be used to predict systolic dysfunction?\u00a0<\/span><\/p>\n

What is the relationship between bedside visual estimates of global cardiac function (GCF) and the calculated LVEF measurements?<\/span><\/p>\n<\/div><\/div>\n

Methods & Study Design<\/h3>
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\u2022 Design\u00a0<\/b><\/span><\/p>\n

This was a prospective observational trial.<\/span><\/p>\n

\u2022 Population\u00a0<\/b><\/span><\/p>\n

A convenience sample of 80 hospitalized patients undergoing comprehensive TTE for any indication. Subjects were recruited between February and April 2012 from an academic level I trauma center. Exclusion criteria were known pregnancy or age less than 18 years.<\/span><\/p>\n

\u2022 Intervention\u00a0<\/b><\/span><\/p>\n

Three emergency ultrasound fellows performed bedside 4-view basic echocardiographic examinations consisting of subxiphoid, parasternal long, and parasternal short and apical views and made estimates of GCF. The fellows then obtained separate parasternal long-axis views and performed M-mode measurements of the EPSS. Comprehensive TTE was separately performed by cardiac sonographers and LVEF was calculated via the Teichholz method. <\/span><\/p>\n

\u2022 Outcomes\u00a0\u00a0<\/b><\/span><\/p>\n