DOPPLER DERIVED MYOCARDIAL PERFORMANCE INDEX (TEI INDEX) IN THE EVALUATION OF PATIENTS WITH HEART FAILURE

Echocardiography is one of the most important noninvasive tests in the evaluation, management and follows up of patient with congestive heart failure.It allows the accurate assessment of structural and functional abnormalities associated with congestive heart failure.Left ventricular ejection fraction (LV EF) is still the most common measurement in the evaluation of heart failure which differentiates heart failure into 2 groups: Heart failure with reduced ejection fraction (systolic heart failure: LV EF is less than 50%) and Heart failure with preserved or normal ejection fraction (Diastolic heart failure: LV EF is equal to or above 50%).LV EF measurement depends upon Left ventricular geometry 1 and diastolic indices are effected by heart rate, loading conditions. 2 Hence there is a need for an index which is affected to a limited extent by these factors and is easy to measure and accurate and easily reproducible.AIM: To evaluate the measurement of myocardial performance index (MPI) as method of evaluation of ventricular function in patients with heart failure secondary to systolic or diastolic dysfunction) in comparison with normal persons.METHODS: A Total of 170 individuals, 60 controls and 120 patients with heart failure who come for echocardiography examination are studied.Patients with organic valvular heart disease and other than sinus rhythm were excluded.Transthoracic echocardiography was done in all cases In addition to the standard echocardiographic measurements, MPI is measured as followed: The time interval from the cessation of onset of next mitral flow (period a: consists of ICT+ET+IVRT) and ventricular ejection time from Doppler outflow spectrum (period b: ET) were measured and MPI was calculated.Myocardial performance index (Tei index) is the ratio between the sum of isovolumic time intervals namely, isovolumic contraction time (ICT) plus isovolumic relaxation time (IVRT)) and ejection time (ET).MPI = (ICT+IVRT) / ET = (a-b)/b = (a/b) -1.Measurements were taken from three consecutive beats and averaged.RESULTS: LV-MPI in normal subjects was 0.32±0.07and it is significantly increased in patients with both systolic and diastolic dysfunction, 0.95±0.26and 0.59±0.13,respectively.RV MPI in normal individuals is 0.23±0.06and significantly increased in patients with LVsystolic function 0.72 ± 0.28, but not in patients with diastolic heart failure0.34±0.15.LV MPI is significantly correlated with Left ventricular ejection fraction and left ventricular dilatation.