Abstract
AimsThe Doppler-derived myocardial performance index (MPI) has been considered as a diagnostic and prognostic Doppler marker for many different clinical conditions. The purpose of this study was to determine the diagnostic accuracy of traditional Pulsed-wave Doppler (PWD-MPI) and Pulsed-wave tissue Doppler imaging (TDI-MPI) and the degree of agreement between these methods in patients with grade-I diastolic dysfunction (DDI) and a normal ejection fraction.MethodsForty-seven consecutive ambulatory patients with DDI were compared to 51 healthy subjects with normal echocardiograms. All subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI.ResultsTDI-MPI and PWD-MPI were significantly higher in patients with DDI than in control subjects: 0.49 ± 0.14 vs. 0.40 ± 0.09 (P < 0.001) and 0.45 ± 0.11 vs. 0.37 ± 0.08 (P < 0.001), respectively. Cutoff values of TDI-MPI > 0.42 and PWD-MPI > 0.40 identified DDI subjects, with sensitivities of 74 and 64%; specificities of 61 and 69%; positive likelihood ratios of 1.9 and 2.0; and negative likelihood ratios of 0.42 and 0.53, respectively; no significant difference was noted between the areas under the ROC curves of TDI-MPI and PWD-MPI (P = 0.77). Bland-Altman plots showed wide limits of agreement between these indices: − 0.17 to 0.23 in healthy subjects and − 0.24 to 0.32 in DDI patients.ConclusionPWD-MPI and TDI-MPI showed poor clinical agreement and were not reliable parameters for the assessment of left ventricular diastolic function.
Highlights
Initial diastolic dysfunction detected by Doppler echocardiography is an independent risk factor for the development of heart failure and all-cause mortality, even in asymptomatic patients [1]
Group I consisted of 51 consecutive healthy adults volunteers without cardiovascular disease and normal echocardiograms and Group II consisted of 47 consecutive hypertensive patients with normal left-ventricle systolic function and grade-I diastolic dysfunction (DDI patients), defined by the presence of impaired relaxation pattern on Doppler (E/A ratio < 0.8), early diastolic velocity of tissue Doppler imaging (e’) measured at the septal mitral annulus < 8 cm/s and at least two of the following additional criteria: deceleration time of the E wave (DT) > 200 ms, early diastolic velocity of tissue Doppler imaging measured at the lateral mitral annulus < 10 cm/s and average E/e’ < 13 [11]
In DDI patients, the tissue Doppler imaging-derived myocardial performance index (TDIMPI) was positively correlated with the diastolic thickness of the interventricular septum (r = 0.37, P = 0.01), left ventricle posterior wall (r = 0.30, P = 0.03), left ventricle mass (r = 0.39, P = 0.03), E/e’ septal (r = 0.36, P = 0.01) and E/e’ and negatively correlated with S septal (r = − 0.38, P = 0.009) e’ septal (r = − 0.41, P = 0.014) and e’/a’ septal (r = − 0.36, P = 0.014)
Summary
Initial diastolic dysfunction detected by Doppler echocardiography is an independent risk factor for the development of heart failure and all-cause mortality, even in asymptomatic patients [1]. One limitation of the conventional Doppler-derived Myocardial Performance Index (PWD-MPI) method is that the measures of time intervals are based on flowvelocity curves and are performed in different cardiac cycles; this method requires several measurements to reduce beat-to-beat variation. An alternative for MPI calculation is the use of the pulsed-wave tissue Doppler imaging-derived myocardial performance index (TDIMPI), which allows simultaneous measurement of both the diastolic and systolic intervals in the same cardiac cycle, with high diagnostic accuracy in subjects with. With the mitral inflow-velocity curve and the e’ velocity obtained from the septal and lateral sides of the mitral annulus, the E/e’ ratios and average E/e’ (septal and lateral) were calculated. The Doppler tracings were obtained at 100 mm/s, and the measures were calculated from an average of five consecutive cardiac cycles
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