Tei index for right ventricular function monitoring in pregnant women complicated with cardiac disease and pulmonary hypertension

Abstract

To investigate clinical value of Tei index used for monitoring right ventricular (RV) function in pregnant women complicating cardiac disease accompanying pulmonary hypertension (PH) and the influence on left ventricular (LV) function due to overload pressure of RV. Fifty-eight pregnant women complicating cardiac disease (including 32 cases with congenital heart disease, 14 cases with rheumatic heart disease and 8 cases with arrhythmia) were enrolled in this study, among 26 cases coexisted with pulmonary hypertension. According to the pressure of PH, those patients were divided into three groups: 11 cases in mild group [30 - 49 mm Hg (1 mm Hg = 0.133 kPa)], 9 cases in moderate group (50 - 79 mm Hg) and 6 cases in severe group (>or= 80 mm Hg). In the mean time, 15 healthy pregnant women were matched as control. Tei index were measured for LV and RV respectively. (1) The isovolumetric relaxation time [IRT, (93 +/- 52) ms] and isovolumetric contraction time [ICT, (66 +/- 41) ms] of RV in PH group were significantly higher than normal controls [(39 +/- 19) ms in IRT and (38 +/- 20) ms in ICT] and the other patients without PH group [(59 +/- 12) ms in IRT and (43 +/- 19) ms in ICT, P < 0.01, P < 0.05; P < 0.05, P < 0.05]; however, ejection time (ET) was (239 +/- 46) ms significantly shortened in PH group (P < 0.05, P < 0.01) when compared with (250 +/- 41) ms in patients without PH and (299 +/- 38) ms in normal controls. Tei index in PH group were 0.72 +/- 0.49, which were significantly higher than 0.38 +/- 0.12 in normal controls and 0.43 +/- 0.16 in patients without PH (P < 0.01, P < 0.05). (2) The IRT [(99 +/- 27) ms] and ICT [(71 +/- 40) ms] of LV in PH group were significantly higher than in normal controls [(88 +/- 20) ms, (50 +/- 24) ms] (P < 0.01, P < 0.01). ET of LV in PH group [(202 +/- 26) ms] were significantly shortened that (290 +/- 21) ms in normal controls and (220 +/- 36) ms in patients without PH (P < 0.01, P < 0.05). Tei index of LV in PH group were significantly higher than 0.43 +/- 0.15 in normal controls and 0.58 +/- 0.21 in patients without PH (P < 0.01, P < 0.05). (3) Positive correlation between Tei index of RV and pressure of pulmonary artery were observed (r = 0.84, P < 0.01). (4) Tei index of RV in severe PH were significantly higher than mild PH (0.75 +/- 0.43 vs. 0.68 +/- 0.35, P < 0.01) and moderate PH (0.75 +/- 0.43 vs. 0.71 +/- 0.14, P < 0.05). (1) The Tei index is a novel efficient Doppler index in assessing RV function of pregnant women complicating cardiac disease accompanying PH. And the fluctuation of Tei index might reflect seriousness of the disease. (2) The overload pressure of RV pressure due to PH has significant influence on LV function.