Long-term prognostic value of an index of myocardial performance in patients with myocardial infarction

The Relationship Between Global Left Ventricular Function, as Indicated by the Tei Index, and Long-Term Survival in Patients With Non-Ischemic, Dilated Cardiomyopathy

AIM

Idiopathic dilated cardiomyopathy (DCM) is one of the leading causes of low ejection fraction (EF) heart failure (HF). The Tei index is a reliable marker that reflects both left ventricular (LV) systolic and diastolic function, and it has prognostic value in patients with DCM. We aimed to investigate the relationship between the Tei index and long-term survival in non-ischemic, DCM patients.

MATERIAL AND METHODS

The present study included 98 patients with non-ischemic DCM. The mean survival time of the patients was 59 mos.

RESULTS

The Tei index was prominently higher in patients who died (0.64±0.08 vs 0.71±0.12, respectively; p=0.01). LV end-systolic volume and LV ejection fraction (LVEF) were independent prognostic factors and predicted worse long-term survival. Additionally, the patients with LVEF ≥32.7 % and the Tei index ≤0.76 had significantly longer survival.

CONCLUSION

The present study showed that the Tei index was significantly associated with mortality and the patients with both low LVEF (≤32.7 %) and high Tei index (≥0.76) values had a shorter life expectancy. As a result, we suggest that the Tei index may be a useful echocardiographic marker to predict long-term survival in DCM patients.

The prognostic value of Tei index in acute myocardial infarction: a systematic review

Background

Echocardiographic evaluation of left ventricular ejection fraction (LVEF) is used in the risk stratification of patients with an acute myocardial infarction (AMI). However, the prognostic value of the Tei index, an alternative measure of global cardiac function, in AMI patients is not well established.

Methods

We conducted a systematic review, using MEDLINE and EMBASE, to evaluate the prognostic value of the Tei index in predicting adverse outcomes in patients presenting with AMI. The data was collected and narratively synthesised.

Results

A total of 16 studies were including in this review with 2886 participants (mean age was 60 years from 14 studies, the proportion of male patients 69.8% from 14 studies). Patient follow-up duration ranged from during the AMI hospitalisation stay to 57.8 months. Tei index showed a significant association with heart failure episodes, reinfarction, death and left ventricular thrombus formation in 14 out of the 16 studies. However, in one of these studies, Tei index was only significantly predictive of cardiac events in patients where LVEF was <40%. In two further studies, Tei index was not associated with predicting adverse outcomes once LVEF, left ventricular end-systolic volume index and left ventricular early filling time was taken into consideration. In the two remaining studies, there was no prognostic value of Tei index in relation to patient outcomes.

Conclusions

Tei index may be an important prognostic marker in AMI patients, however, more studies are needed to better understand when it should be used routinely within clinical practice.

Myocardial performance index is associated with cardiac computed tomography findings in patients with suspected coronary artery disease

BACKGROUND

Studies suggest cardiac time intervals to be associated with cardiac ischemia. A novel method to assess cardiac time intervals by tissue Doppler echocardiography has been proposed. Cardiac time intervals can assess the myocardial performance index (MPI), which quantifies the proportion of time spent contributing effective myocardial work. We hypothesized that MPI associates with coronary artery lesions detected by cardiac computed tomography (CT) in patients suspected of coronary artery disease (CAD).

METHODS

We investigated patients referred for cardiac CT under suspicion of CAD who had an echocardiogram performed. Curved m-mode tissue Doppler imaging was used to measure cardiac time intervals and MPI. The outcome was coronary artery lesions, defined as a calcium score > 400 and/or coronary artery stenosis (>70% luminal narrowing). Logistic regression was applied with multivariable models including: (a) SCORE chart risk factors and (b) SCORE chart risk factors, body mass index, dyslipidemia, familial history of CAD, diabetes mellitus, LVEF, and left ventricular mass index.

RESULTS

Of 404 patients, 41 (10%) had a coronary artery lesion. Overall, 42% were male, mean age was 58 years, and LVEF was 58%. Patients with coronary artery lesions exhibited higher MPI than those without (0.52 vs. 0.44, P < .001). MPI associated with coronary artery lesions in unadjusted analyses (OR = 1.69 [1.30-2.19], per 0.1 increase), and this association persisted when adjusted for SCORE chart risk factors (OR = 1.55 [1.16-2.07], P = .003, per 0.1 increase), and additional risk factors (OR = 1.64 [1.11-2.41], P = .013, per 0.1 increase).

CONCLUSION

Curved m-mode-derived MPI is associated with coronary artery lesions detected by cardiac CT in suspected CAD patients.

The prognostic value of mechanical left ventricular dyssynchrony in patients with acute coronary syndrome

Background

Echocardiography is a well-established tool for risk stratification in patients with acute coronary syndrome (ACS). ACS has significant impact on LV dyssynchrony, and detrimental effects on systolic function and long term outcome. The aims of this study were to determine whether LV dyssynchrony carries any predictive information in an unselected ACS population and to evaluate if it has any incremental value to the information given from conventional echocardiographic measurements.

Methods

The study included 227 consecutive ACS patients. Primary endpoint was the composite of death, new MI, or rehospitalisation due to heart failure. Dyssynchrony was measured as intersegmental variation of time to peak strain, the post systolic index (PSI) and myocardial performance index (MPI) with the standard deviation and difference between lowest and highest value (delta) expressing the amount of dyssynchrony. Septal-lateral delay was also tested. All dyssynchrony parameters were compared with Ejection fraction (EF).

Results

The median follow up time was 53 months. 85 patients reached the combined endpoint. Patients with and without a subsequent combined endpoint differed significantly regarding calculated SD: s and delta-value for PSI, time to peak 2D-strain and MPI but not regarding septal-lateral delay. In ROC-analysis none of the dyssynchrony parameters had larger AUC than EF. When adjusting for traditional risk factors none of the dyssynchrony parameters remained associated with outcome, whereas EF still did.

Conclusion

LV dyssynchrony seem to have significant prognostic information in patient with acute coronary syndrome but in comparison to conventional parameters such as EF there is no incremental value of this information.

Index of myocardial performance in patients with type 2 diabetes without hypertension and its relationship with clinical and echocardiographic parameters

BACKGROUND

Diabetes mellitus affects the systolic and diastolic function of the left ventricle (LV). The aim of the present study was to evaluate the index of myocardial performance (IMP), a new Doppler index, in asymptomatic, normotensive patients with type 2 diabetes mellitus (T2DM).

METHODS

The study population consisted of 40 asymptomatic normotensive patients with T2DM (22 women, 18 men; mean [±SD] age 49 ± 7 years) and 20 healthy controls (13 women, seven men; mean age 45 ± 4 years). M-Mode and two-dimensional Doppler echocardiography was performed in all subjects to calculate IMP. Venous blood samples were collected for analysis and body mass index (BMI) was calculated.

RESULTS

In normotensive T2DM patients, the mitral E wave was decreased, whereas mitral A wave, mitral E/A ratio, and septal wall thickening were increased compared with values obtained for the control group. The IMP was higher in normotensive T2DM patients than in the control group (P = 0.004). There was a significant correlation between IMP and triglyceride (TG) levels (P < 0.001), mitral E wave (P < 0.001), mitral E/A ratio (P < 0.001), ejection fraction (P = 0.001), fasting blood glucose (P =0.007), LV systolic dimension (P < 0.001), duration of diabetes (P = 0.017), and BMI (P = 0.029). Stepwise multiple regression analysis demonstrated that only TG levels (β = 0.355, t = 2.487, P = 0.017) and the mitral E/A ratio (β = -0.384, t = -2.690, P = 0.011) had an independent effect on IMP.

CONCLUSION

The results of the present study indicate that IMP is increased in normotensive T2DM patients. The findings suggest that increased IMP may be an early sign of diabetic cardiomyopathy in normotensive diabetic patients with preserved LV function.

Is the aging heart similar to the diabetic heart? Evaluation of LV function of the aging heart with Tissue Doppler Imaging

BACKGROUND AND AIMS

Left ventricular (LV) function in the healthy aging heart is modified by biochemical changes with advancing age. We employed for the first time Tissue Doppler Imaging (TDI), to identify which phase of the cardiac cycle is involved.

METHODS

TDI was performed in 175 aging subjects, free of cardiovascular and/or respiratory disease (group II), and in 182 healthy adults enrolled as the control group (group I), to calculate the Myocardial Performance Index (MPI). The index derives from the values of Isovolumetric Contraction Time (ICT), Isovolumetric Relaxation Time (IRT) and Left Ventricular Ejection Time (LVET) measured in ms, according to the formula: (ICT+IRT)/LVET.

RESULTS

An increase in MPI in group II was shown, with significant lengthening of IRT in comparison with the same value obtained in the control group (group I), ICT and LVET were unchanged.

CONCLUSIONS

The rise in IRT in the aging healthy heart is dependent on diastolic LV dysfunction consequent upon the formation of Advanced Glycosilation End-product (AGE) crosslinks with connectival proteins of interstitial myocardial tissue. Agerelated increase in oxidative stress also modifies some interstitial compounds, favoring hardening of ventricular walls. These changes are similar to those happening in the diabetic heart, and TDI seems to be able to define non-invasively which phase of the cardiac cycle is impaired.

Restrictive diastolic filling predicts death after acute myocardial infarction: systematic review and meta-analysis of prospective studies

OBJECTIVE

To determine, through a systematic review and meta-analysis, the magnitude of the survival deficit associated with a restrictive filling pattern after acute myocardial infarction (AMI).

METHODS

Online databases were searched for prospective echocardiography outcome studies of patients after AMI. All authors were contacted to seek confirmation of their data. Restrictive filling was compared with all non-restrictive filling patterns. Review Manager Version 4.2.7 software was used for analysis.

RESULTS

3855 patients in 16 studies were identified. Follow up varied from two weeks to five years (> 1 year, 10 studies; and > 4 years, four studies). 776 (20%) of patients had a restrictive filling pattern at baseline. 580 patients died (247 in the restrictive group), and the overall odds ratio for death (restrictive filling worse) was 4.10 (95% confidence interval 3.38 to 4.99).

CONCLUSIONS

Mortality is about four times higher in patients with a restrictive filling pattern than in those with non-restrictive filling patterns after AMI. Echocardiographic assessment of diastolic filling pattern is an important part of the echocardiographic assessment of patients after myocardial infarction and provides important prognostic information about such patients.

Risk Assessment in Patients with Depressed Left Ventricular Function After Myocardial Infarction Using the Myocardial Performance Index–Survival and Ventricular Enlargement (SAVE) Experience

BACKGROUND

Myocardial performance index (MPI) is a noninvasive, quantitative Doppler measure of global cardiac function, integrating systolic and diastolic functions. The prognostic significance of MPI is less clear for cardiovascular (CV) events after myocardial infarction (MI) among individuals at high risk with depressed left ventricular (LV) systolic function.

METHODS

We analyzed echocardiograms from 512 patients with depressed LV function after MI enrolled in the Survival and Ventricular Enlargement (SAVE) echocardiographic substudy. Baseline MPI measures were obtainable in 226 patients. The cohort was separated by median MPI (0.50). MPI was related to baseline clinical and echocardiographic characteristics, ventricular remodeling, and subsequent CV events, including recurrent MI, heart failure, CV death, and a composite of all CV end points.

RESULTS

An MPI of 0.5 or more was associated with larger infarct size and reduced LV systolic function at baseline; other baseline characteristics between the groups were similar. A total of 64 (28.3%) patients experienced CV events. Baseline MPI did not influence ventricular remodeling and did not modify the relationship between ventricular dilatation and CV events. After covariate adjustment, an MPI of 0.50 or higher remained an independent predictor for adverse CV events (hazard ratio [HR], 2.00, 95% confidence interval 1.17-3.43).

CONCLUSIONS

An MPI of 0.50 or greater is an independent predictor for CV events after MI in patients with known LV dysfunction.

Myocardial performance index for assessment of left ventricular outcome in successfully recanalised anterior myocardial infarction

OBJECTIVE

To investigate whether the myocardial performance index (MPI) can predict left ventricular functional outcome in patients with early recanalisation after anterior acute myocardial infarction (MI) and to determine when the index should be measured.

DESIGN

MPI was measured serially by two dimensional Doppler echocardiography after successful percutaneous coronary intervention (PCI). Left ventricular function was evaluated by echocardiography and left ventriculography. To assess coronary microvascular damage, the coronary flow velocity pattern was measured immediately after PCI with a Doppler guidewire.

SETTING

Hiroshima City Asa Hospital.

PATIENTS

32 consecutive patients with their first anterior acute MI who had complete occlusion of left anterior descending coronary artery.

INTERVENTIONS

Successful PCI within six hours of symptom onset.

MAIN OUTCOME MEASURES

Left ventricular anterior wall motion score index (A-WMSI), left ventricular end diastolic pressure (LVEDP), left ventricular ejection fraction (LVEF), and left ventricular end diastolic volume (LVEDV).

RESULTS

There was a significant negative correlation between MPI on day 2 and the coronary diastolic deceleration time (r = -0.66, p < 0.002), as well as a significant positive correlation with the coronary diastolic deceleration rate (r = 0.74, p < 0.0001). MPI on day 2 was significantly correlated with the short and long term changes of A-WMSI and with the short term changes of LVEDP. Furthermore, MPI on day 2 was significantly correlated with the short and long term changes of LVEF (r = -0.52, p < 0.003, and r = -0.64, p < 0.0008, respectively) and of LVEDV (r = 0.51, p < 0.003, and r = 0.41, p < 0.05, respectively).

CONCLUSIONS

Doppler derived MPI on day 2, representative of the early coronary microvascular state, can predict the left ventricular functional outcome after early successful recanalisation of a patient's first anterior acute MI.

Noninvasive prediction of complications with anteroseptal acute myocardial infarction by left ventricular Tei index

BACKGROUND

Tei index has been proposed as a noninvasive and simple index that enables the evaluation of global left ventricular (LV) function and prediction of patient prognosis. However, its use to predict complications with acute myocardial infarction (AMI) is not fully investigated. Therefore, the purpose of this study was to investigate whether or not LV Tei index allows noninvasive prediction of complications with AMI.

METHODS

In all, 80 consecutive patients with anteroseptal AMI were enrolled. LV Tei index was measured at the time of admission as (a - b)/ b , where a is the interval between cessation and onset of mitral filling flow and interval b is the aortic flow ejection time. Subsequent complications including cardiac death, shock, congestive heart failure, ventricular tachycardia/fibrillation, paroxysmal atrial fibrillation/flutter, advanced atrioventricular block requiring pacing, pericardial effusion, and LV aneurysm during the 30 days after the onset of AMI were prospectively evaluated and compared with the initial Tei index at admission.

RESULTS

Complications developed in 31 of 80 (39%) patients with AMI. The Tei index was significantly increased for patients with complications compared with those without them (0.69 +/- 0.16 vs 0.50 +/- 0.11, P < .0001). When Tei index > or = 0.59 was used for the criteria, the sensitivity, specificity, and overall accuracy to predict subsequent complications were 77%, 86%, and 85%, respectively.

CONCLUSION

In patients with anteroseptal AMI, LV Tei index at arrival to the hospital in the acute phase allows noninvasive prediction of subsequent complications.

Echocardiographic assessment of global ventricular function using the myocardial performance index in rats with hypertrophy

Myocardial hypertrophy is the hallmark of chronic pressure overload and the myocardial performance index (MPI) is an easily recordable measurement of Doppler time intervals. In this study, the utility of using MPI to assess the progression of hypertrophy in the aortic-banded rat model was evaluated. Male Wistar rats (70-90 g) underwent ascending aorta constriction (n = 4) or a sham operation (n = 5). High-resolution echocardiography was performed 4, 7, 10, and 12 weeks after the surgery. Over this follow-up interval, animals in the aortic-banded group demonstrated an increase in their mean left ventricular (LV) mass and MPI compared with controls. MPI reflects ventricular performance in small animals with LV hypertrophy, showing alterations early after aorta constriction.

Index of myocardial performance after early phase of myocardial infarction in relation to its location

To define the degree of heart derangement in recent myocardial infarction (MI) occurring in different wall locations of myocardium, we echocardiographically evaluated left ventricular volumes, ejection fraction, wall-motion score index, isovolumetric contraction and relaxation time, ejection time, and index of myocardial performance in 74 patients with MI. Participants were chosen among the patients with MI of comparable extent and interesting unlike zones of myocardial walls. Mean values of evaluated left ventricular end-diastolic and end-systolic volumes and ejection fraction were nearly alike in all patients, whereas wall-motion score index and index of myocardial performance were cleary prolonged in those with anterior MI in comparison with the values recorded in patients with lateral or inferior MI. The mean values of isovolumetric contraction and relaxation time suggest that a prevalent systolic dysfunction is present in the early phase of MI. In addition, the different index of myocardial performance prolongation in MI otherwise located suggests evidence that MI located in the anterior wall has more serious effect than lateral or inferior MI.