ResUS Pearl: Detecting decreased LVEF with E point septal separation

EPSS of >7mm is 100% sensitive and 51% specific for EF < 30% when performed by Emergency Physicians

Technique

• Obtain an M-Mode image through the tip of the mitral valve in the parasternal long axis view. 
• The distance between the maximum early opening point (the E point) and the septum is known as  E-point septal separation (EPSS). 

In a normal M-mode tracing of the mitral valve, there are two peaks during diastole. The first is the E wave, indicating early passive filling. The second is the A wave which occurs with a late diastolic atrial kick, just before  the valve closes.

Normal EPSS should be close to 0mm.

Widened EPSS (note: nonstandard orientation)

Caveats 

Patients with mitral valve abnormalties and aortic regurgitation may not have an accurate EPSS

Mitral Stenosis:

The normally appearing dip between the E and A points is gone

Aortic regurgitation:

There is fluttering of the anterior mitral valve between the E and the A peaks
from the regurgitant flow from the aorta during diastole

References

McKaigney CJ, Krantz MJ, et al.
E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction.
Am J Emerg Med. 2014

Dina Seif, Phillips Perera, Thomas Mailhot, David Riley, and Diku Mandavia.
Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol.
Crit Care Res Pract. 2012

Butts, C.
The Speed of Sound: Utilizing E-Point Septal Separation for Measuring Ventricular Function.
Emergency Medicine News: January 2014


Thomas Binder, MD, et al.
Interactive Echocardiography. A Clinical Atlas. Futura, 1997. via UpToDate

Submitted by: K Bryant, MD