The relationship of tissue Doppler Tei index with invasive hemodynamic parameters in patients with heart failure

Abstract

Purpose: The myocardial performance index (Tei index) reflects both systolic and diastolic function of the heart and it's easily applied in the practice. In this study; we aimed to determine the relationship between Tei index and invasive hemodynamic parameters in heart failure patients. Methods: 126 patients (pts) with heart failure were selected for the study. Diagnostic cardiac catheterizations were performed in all patients. The pts were divided into 2 groups. Group I consisted of 59 pts (32 men, mean age 61±10, Functional capacity NYHA Class I and LVEDP<16 mmHg). Group II were containing 67 pts (34 men, mean age 60±9,NYHA Class≥II, LVEDP≥16 mmHg).The following parameters were measured in all pts: Ejection fraction, the peak mitral early (E) and late (A) diastolic velocities, E/A ratio, Deceleration time (DT) and also tissue Doppler parameters were measured from 4 different areas of the mitral annulus (septum, lateral, inferior, anterior). In order to measure Tei index with 2 methods (Standard Doppler and tissue Doppler method); isovolumic contraction time (IVCT), Isovolumic relaxation time (IVRT) and ejection time (ET) were measured from 4 areas and mean values of Tei index was calculated. Results: E/A ratios, DT and IVRT were not found different between two groups (p>0.05).Group II pts had longer IVCT and ET (p<0.05).Tei index measured by both standard pulsed wave Doppler and tissue Doppler method were significantly higher in group II pts (Group I:0.50±0.2 and 0.50±0.14; Group II:0,98±0.3, 1.2±0.32, p<0.001). According to ROC (Receiver Operating Characteristics) curve analysis the cut off value for Tei index measured by tissue doppler was found 0.74. The sensitivity and specificity of this value were measured 92.5% and 91.5% respectively. Tei index measured by Standard Doppler method was 0.67. Its sensitivity and specificity were 77% and 72%.We found a strong relationship between Tei index especially measured by tissue doppler and left ventricular end diastolic pressure (r=0.83,p<0.01; r=0.96, p<0.01). Additionally, it was found a significant relationship between Tei index values measured by tissue Doppler and those measured by standard traditional method (r= 0.85,p<0.01). Conclusions: In this study we showed that Tei index measured with both pulsed wave Doppler and tissue Doppler was reliable for the evaluation of the global cardiac functions in pts with heart failure. It can be said that myocardial performance index measured with the tissue Doppler method is better than traditionally measured Tei index to differentiate the pts with the symptomatic heart failure from the asymptomatic cases.