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Abstract

Background

E-point septal separation (EPSS) and tricuspid annular plane systolic excursion (TAPSE) are M-mode measures of left and right ventricular systolic function, with limited pediatric point-of-care ultrasound (POCUS) research.

We conducted a cross-sectional study in a pediatric emergency department, enrolling 12–17-year-olds without cardiopulmonary complaints. Exclusion criteria included abnormal vital signs, fever, altered mental status, or psychiatric illness.

POCUS faculty performed the measurements, while blinded to pediatric echocardiography reference values. Data was analyzed using unpaired t-tests and Pearson’s correlation. Correlations with age, height, weight, body mass index, and heart rate were examined.

Twenty subjects were enrolled. The mean EPSS was 2.5 mm (SD 1.9 mm), and the mean TAPSE was 2.6 cm (SD 0.4 cm), aligning with pediatric echocardiography reference values. No significant correlations were found between EPSS or TAPSE and anthropometric data.

Methods

We conducted a cross-sectional study in a tertiary care pediatric emergency department, between September 2021 and June 2022. Adolescents were eligible for inclusion if they presented with non-cardiopulmonary conditions, while exclusion criteria included abnormal vital signs, fever, altered mental status, or acute psychiatric illness.

POCUS evaluations were performed by POCUS faculty board-certified in pediatric emergency medicine and experienced in cardiac ultrasound, each having performed more than 500 cardiac POCUS on pediatric patients.

The senior investigator had completed a POCUS fellowship. Sonologists were blinded to reference values during the study period to reduce potential bias.

Patient height was obtained via verbal report, and weight was recorded from the electronic medical record. EPSS and TAPSE measurements were acquired using a Philips Ultrasound Sparq system.

For EPSS, the phased-array probe was positioned in the parasternal long axis view, and M-mode was used to measure the shortest distance between the anterior mitral valve leaflet and the ventricular septum during diastole. A distance of 0 mm was recorded if the leaflet contacted the septum (Fig. 1).

For TAPSE, the probe was positioned to obtain an apical four-chamber view, and M-mode was used to measure the displacement of the tricuspid annulus during systole. The tricuspid annulus motion was measured as the distance between the apogee and the lowest point of motion seen on the screen (Fig. 2). Images were saved in a POCUS workflow manager (Qpath, Version 2.24.513 © 2024 Telexy, Inc.) for review as necessary.

Results

A total of 20 adolescents were enrolled, with a mean age of 14.75 years; 55% were female. The principal investigator enrolled 16 subjects. The other POCUS faculty members enrolled 2 subjects each. POCUS evaluations were successfully performed in all subjects, and no difficulties were encountered in obtaining the required imaging windows or measurements.

The mean EPSS measured by POCUS was 2.5 mm (95% CI: 0.6–4.4 mm). Five patients (25%) had an EPSS of 0 mm, indicating that the mitral valve leaflet contacted the septum during diastole. There was no statistically significant difference between POCUS-derived EPSS values and echocardiography standards (p = 0.42 and 1.0). The mean TAPSE measured by POCUS was 2.6 cm (95% CI: 2.2–3.0 cm). There was no statistically significant difference between POCUS-derived TAPSE values and echocardiography standards (p = 0.91).

While TAPSE demonstrated a weak positive correlation with weight (r = 0.47, p = 0.037), no significant correlations were identified between EPSS and anthropometric variables (Table 1).

Conclusions

This pilot study establishes that POCUS-derived EPSS and TAPSE measurements in healthy adolescents are comparable to pediatric echocardiography reference values.

READ MORE HERE: https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-025-00407-7

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