Use of e-point septal separation to screen for left ventricular function in children

Objective

E-point septal separation (EPSS) is a point-of-care ultrasound measurement used to screen for left ventricular systolic dysfunction (LVSD) in adults. We evaluated the distribution of EPSS in children and determined the association between EPSS and presence/extent of LVSD.

Methods

We conducted a retrospective single-center study of pediatric echocardiograms performed between January 2019 and February 2023. Our outcome was LVSD (as mild, moderate, and severe based on ejection fraction and/or fractional shortening criteria). We evaluated the association between EPSS and LVSD and moderate-severe systolic dysfunction. We reported sensitivity, specificity and predictive values when using 7.0 mm (commonly used adult criteria) and statistically-selected EPSS thresholds.

Results

We included 770 echocardiograms; 148 had LVSD (104 mild, 32 moderate, and 12 severe). EPSS increased with increasing LVSD. The area under the receiver operator curve (AUROC) was 0.92 (95 % confidence interval [CI] 0.89–0.95) for EPSS and any LVSD and 0.94 (95 % CI 0.87–1.00) for EPSS and moderate-severe systolic dysfunction. Using a 7.0 mm threshold for any LVSD, sensitivity was 76.4 % (95 % CI 68.5–82.8 %) and specificity was 95.8 % (95 % CI 93.8–97.2 %). An optimal threshold of 6.0 mm improved sensitivity to 81.8 % (95 % CI 74.4–87.4 %). For children 0–3 years old, a threshold of 4.9 mm demonstrated better sensitivity (77.8 %, 95 % CI 51.9–92.6 %) compared to the 7.0 mm threshold (55.6 %, 95 % CI 31.3–77.6 %). For children >3 years old, the 7.0 mm and optimal thresholds performed similarly for moderate-severe systolic dysfunction.

Conclusions

EPSS is a promising screening technique for pediatric LVSD. The 7.0 mm threshold may be an adequate screen for older children.