Skip Navigation

European Heart Journal 2000 21(22):1888-1895; doi:10.1053/euhj.2000.2246
Copyright © 2000 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (86)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Bruch, C
Right arrow Articles by Erbel, R
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bruch, C
Right arrow Articles by Erbel, R
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Tei-Index in patients with mild-to-moderate congestive heart failure

C Bruchf1, A Schmermund, D Marin, M Katz, T Bartel, J Schaar and R Erbel

Department of Cardiology, University of Essen, Germany

Received April 4, 2000; accepted April 5, 2000

Abstract

Background Congestive heart failure is related to contraction and relaxation abnormalities of the ventricle. Isolated analysis of either mechanism may not be reflective of overall cardiac dysfunction. A combined myocardial performance index (isovolumic contraction time plus isovolumic relaxation time divided by ejection time, ‘Tei-Index’) has been described which may be more effective for analysis of global cardiac dysfunction than systolic and diastolic measures alone. It was the aim of the present investigation to evaluate the Tei-Index against invasive examination.

Methods and Results Eighty-one subjects were included in a consecutive manner, among 125 patients undergoing left heart catheterization for invasive measurement of left ventricular end-diastolic pressure; 43 patients had congestive heart failure (35 male, 8 female, 68±6 years) defined by NYHA functional class ≥2 (mean 2·5±0·5) and left ventricular end-diastolic pressure ≥16mmHg (mean 20±4) and 38 subjects (32 male, 6 female, 66±5 years) without symptoms of heart failure (NYHA functional class I) and with normal left ventricular end-diastolic pressure (mean 12±3mmHg) served as a control group. Using conventional echo-Doppler methods, parameters assessed were: ejection fraction, peak velocities of early (E) and late (A) diastolic filling, the E/A ratio, deceleration time, isovolumic contraction time, isovolumic relaxation time and ejection time. The Tei-Index was obtained by subtracting ejection time from the interval between cessation and onset of the mitral flow. The control group and patients with congestive heart failure did not differ with respect to the E/A ratio (0·86±0·27 vs 0·90±0·44, P=ns), deceleration time (203±42ms vs 206±36ms,P =ns) and isovolumic relaxation time (97±16ms vs 94±26ms, P=ns). The ejection fraction was slightly reduced in patients with congestive heart failure (46±11% vs 55±8%,P <0·05). The Tei-Index was easily and reproducibly measured in all subjects. The mean value of the Tei-Index was significantly different between the control group and patients with congestive heart failure (0·39±0·10 vs 0·60±0·18, P<0·001). Receiver operating characteristic curve analysis for the Tei-Index yielded an area under the curve of 0·88±0·038. Using a Tei-Index ≥0·47 as the cutpoint, congestive heart failure was identified with a sensitivity of 86% and a specificity of 82%. No correlation was observed between the Tei-Index and heart rate (r=0·22, P=ns), systolic blood pressure (r=0·16,P =ns) or diastolic blood pressure (r=0·08, P=ns). The Tei-Index was significantly related to left ventricular end-diastolic pressure (r=0·46,P <0·01).

Conclusion The Tei-Index is a sensitive indicator of overall cardiac dysfunction in patients with mild-to-moderate congestive heart failure. The Tei-Index is easily obtained and may be used in the work-up of patients with suspected cardiac dysfunction.

Key Words: Congestive heart failure, combined myocardial performance index, Tei-Index, left ventricular ejection fraction, left ventricular end-diastolic pressure.

f1 Correspondence: Dr Christian Bruch, University of Essen, Department of Cardiology, Hufelandstr. 55, 45122 Essen, Germany.

References

  1. Yusuf S, Thom T. Changes in hypertension treatment and in congestive heart failure mortality in the United States. Hypertension. 1989;13:174–179
  2. Wilson JR, Ferraro N. Exercise intolerance in patients with chronic left heart failure: relation to oxygen transport and ventilatory abnormalities. Am J Cardiol. 1983;51:1358–1363[CrossRef][ISI][Medline]
  3. Grossmann W. Diastolic dysfunction in congestive heart failure. Semi Med Beth Israel Hosp. 1991;325:1557–1564
  4. Schiller NB, Shah PM, Crawford M. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echo. 1989;2:358–367[Medline]
  5. Kitabake A, Inoue M, Asa M. Transmitral blood flow reflecting diastolic behavior of the left ventricle in health and disease: a study by pulsed Doppler technique. Jpn J Circ. 1982;46:92–102
  6. Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc. 1989;64:181–204[ISI][Medline]
  7. Oh JK, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik JA. The non-invasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiogrphy. J Am Soc Echocardiogr. 1997;10:246–270[CrossRef][ISI][Medline]
  8. Tei C, Ling LH, Hodge DO. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26:357–366[Medline]
  9. Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol. 1995;26:396–404
  10. Tei C, Dujardin KS, Hodge DO, Kyle RA, Tajik AJ, Seward BJ. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol. 1996;28:658–664[Abstract]
  11. Quinones MA, Waggoner AD, Reduto LA. A new simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation. 1981;64:744–753[Abstract/Free Full Text]
  12. Klein AJ, Burstow DJ, Tajik AJ. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. 1994;69:212–224[ISI][Medline]
  13. Rakowski H, Appleton C, Chan KL. Canadian consensus recommendations for measurement and reporting of Diastolic dysfunction by echocardiography. J Am Soc Echocardiogr. 1996;9:736–760[CrossRef][Medline]
  14. Griner PF, Mayewski RJ, Mushlin AI, Greenland P. Selection of diagnostic tests and procedures. Ann Int Med. 1981;94:555–600
  15. Weissler AM, Harris WS, Schoenfeld CD. Systolic time intervals in heart failure in man. Circulation. 1968;37:149–159[Abstract/Free Full Text]
  16. Stack RS, Lee CC, Reddy BP, Taylor ML, Weissler AM. Left ventricular performance in coronary artery disease evaluated with systolic time intervals and echocardiography. Am J Cardiol. 1976;37:331–339[CrossRef][ISI][Medline]
  17. Weissler AM, Peeler RG, Roehll WH Jr. Relationships between left ventricular ejection time, stroke volume, and heart rate in normal individuals and patients with cardiovascular disease. Am Heart J. 1961;62:367–378[CrossRef][ISI][Medline]
  18. Tenenbaum A, Motro M, Hod H, Kaplinky E, Vered Z. Shortened Doppler-derived mitral A wave deceleration time: an important predictor of elevated left ventricular filling pressure. J Am Coll Cardiol. 1996;27:700–705[Abstract]
  19. Nishimura RA, Tajik JA. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta stone. J Am Coll Cardiol. 1997;30:8–18[Abstract]
  20. Thomas JD, Weyman AE. Echo Doppler evaluation of left ventricular diastolic function: physics and physiology. Circulation. 1991;84:977–990[Free Full Text]
  21. Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988;12:426–440[Abstract]
  22. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue imaging: a non-invasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527–1533[Abstract]
  23. Stugaard M, Risoe C, Ihlen H, Smiseth OA. Intracavitary filling pattern in the failing left ventricle assessed by color M-mode Doppler echocardiography. J Am Coll Cardiol. 1994;24:663–670[Abstract]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
N. Mabrouk-Zerguini, P. Leger, S. Aubert, R. Ray, P. Leprince, B. Riou, P. Coriat, and A. Ouattara
Tei index to assess perioperative left ventricular systolic function in patients undergoing mitral valve repair
Br. J. Anaesth., July 17, 2008; (2008) aen212v1.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Physiol. Heart Circ. Physiol.Home page
Y. Hori, T. Kano, F. Hoshi, and S.-i. Higuchi
Relationship between tissue Doppler-derived RV systolic function and invasive hemodynamic measurements
Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H120 - H125.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
J. Arnlov, E. Ingelsson, U. Riserus, B. Andren, and L. Lind
Myocardial performance index, a Doppler-derived index of global left ventricular function, predicts congestive heart failure in elderly men
Eur. Heart J., December 2, 2004; 25(24): 2220 - 2225.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
M. M.H. Cheung, J. F. Smallhorn, A. N. Redington, and M. Vogel
The effects of changes in loading conditions and modulation of inotropic state on the myocardial performance index: comparison with conductance catheter measurements
Eur. Heart J., December 2, 2004; 25(24): 2238 - 2242.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
M. St. John Sutton and S.E. Wiegers
The Tei Index--a role in the diagnosis of heart failure?
Eur. Heart J., November 2, 2000; 21(22): 1822 - 1824.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (86)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Bruch, C
Right arrow Articles by Erbel, R
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bruch, C
Right arrow Articles by Erbel, R
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?