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LV end-systolic eccentricity index as a way to quantify septal deformation
LV end-systolic eccentricity index as a way to quantify septal deformation
Eccentricity index (RV-LV Interaction: D1/D2) (Normal < 1.23)
RV/LV ratio (marker of RV dilation: D3/D2) (Normal < 1.00)
References:
Jone JG, Ivy D, Frontiers in Pediatrics - November 2014 , Volume 2, Article 124
Nagiub M, Echocardiography 2015;32:819–833
The following image is from the above article. The article outlines:
Systolic septal flattening recognized at EIs ≥ 1.15.
High inter-observer agreement for EIs.
Quantitative parameters of RV systolic function were impaired only at EIs ≥ 1.3.
Reference: Echocardiography 2016;33:910–915
Eccentricity index (RV-LV Interaction: D1/D2)
Normal < 1.23
At NeoCardioLab, based on literature below - Often used as abnormal if 1.3 or more
RV/LV ratio (marker of RV dilation: D3/D2)
Normal < 1.00
Septal curve at peak of systole: Round, Flat, Bowing / Eccentricity Index at peak of systole
Here the eccentricity index is 1.54/0.73 = 2.11 (well above 1.3)
Septal Flattening
Septal Flattening
Examples of progressive septal flattening at end of systole. One can appreciate on the last panel the severe RV dilation and pan-caking of the LV.
We can appreciate the septum bowing towards the left ventricle in systole. With this appearance, we suspect iso to supra-systemic RV systolic pressure.
From King ME et al. Circulation 1983. - "Marked exaggeration of this configurational change occurred in patients with right ventricular systolic hypertension (right ventricular systolic pressure greater than 50% systemic pressure), with progressive loss of curvature from end-diastole (0.45 ± 0.05) to end-systole (0.19 ± 0.06)."
End-systolic septal flattening is typically seen once RV systolic pressure is at least about 50% of systemic and becomes more marked as RVSP approaches systemic levels. It is therefore a sensitive but not perfectly specific marker of RV systolic hypertension, and the exact % cannot be read off visually without quantitative indices (eccentricity index, septal flattening angle) or TR gradient.
Important papers
Important papers
nihms848246.pdfNormal_Echocardiographic_Reference_Values_of_the_R.pdfking-et-al-1983-interventricular-septal-configuration-as-a-predictor-of-right-ventricular-systolic-hypertension-in.pdfcritser-et-al-2020-cardiac-magnetic-resonance-imaging-evaluation-of-neonatal-bronchopulmonary-dysplasia-associated.pdfburkett-et-al-2020-relationship-between-left-ventricular-geometry-and-invasive-hemodynamics-in-pediatric-pulmonary.pdfEchocardiography - 2016 - Abraham - Left Ventricular End‐Systolic Eccentricity Index for Assessment of Pulmonary.pdf
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