Abstract 2286: Pseudonormalization Tendency of the Tei Index at High Filling Pressures -A Serious Limitation for its Use as a Myocardial Performance Index

Background: The potential advantage provided by the combination of systolic and diastolic parameters makes the Tei index (myocardial performance index) attractive. This index is prolonged during mild or moderate left ventricular (LV) systolic dysfunction. The influence of diastolic dysfunction is unclear. We assessed the reliability of the Tei index for the evaluation of LV dysfunction, in relation to the severity of systolic and/or diastolic impairment. Methods: To evaluate the systolic LV dysfunction associated with various degrees of diastolic dysfunction by the Tei index, the isovolumetric contraction and relaxation time (IVCT and IVRT) and the ejection time were measured by continuous wave Doppler in 155 consecutive patients accepted for heart transplantation (HTx) because of advanced dilated cardiomyopathy (DCM). To evaluate the diastolic dysfunction by the Tei index, the same Doppler measurements were performed in 200 HTx patients who showed isolated diastolic LV dysfunction with normal ejection fraction (LVEF ≥ 55%). Results: Although the Tei index was prolonged (0.67 ±0.16) in DCM patients, there was no correlation between LVEF and Tei index. The Tei index was even lower in NYHA IV in comparison to NYHA II–III patients (0.56 ±0.11 vs. 0.76 ±0.14; p <0.001)). The LVEF was 17.5 ±5% in NYHA IV and 27.2 ±6% in NYHA II–III patients (p <0.01). The IVRT was shorter (p<0.001) in NYHA IV (60.8 ±13 ms) than in NYHA II–III patients (113.9 ±19.5 ms). After HTx, due to initially prolonged IVRT, the Tei index was higher before than after the 1 st post-HTx year (0.54 ±0.08 vs. 0.45 ±0.08; p<0.01). The Tei index was also lower (p<0.05) in patients with coronary allograft vasculopathy (CAV), than in those without (0.42 ±0.10 vs. 0.48 ±0.09). For both DCM and HTx patients there was a correlation between IVRT and Tei index (p <0.001; r = 0.71 and r =0.72, respectively) and also between LV enddiastolic pressure and Tei index (p <0.001; r = −0.69 and r = −0.74, respectively). Conclusions: The shortening of the IVRT due to the elevation of filling pressures in both severe systolic dysfunction (i.e. advanced DCM) and isolated diastolic dysfunction (post-HTx CAV) lowers the Tei index (pseudo-normalization tendency) and thus, in these clinical situations, the Tei index becomes misleading.