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Isa Tafreshi R, Radgoodarzi M, Arjmandi Rafsanjani K, Soheilipour F. Subclinical Left Ventricular Dysfunction in Children and Adolescence With Thalassemia Intermedia. Front Pediatr 2022; 10:774528. [PMID: 35783313 PMCID: PMC9249082 DOI: 10.3389/fped.2022.774528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cardiac complications are important causes of morbidity in patients with thalassemia intermedia (TI). We aimed to assess left ventricular (LV) function, using new tissue Doppler imaging (TDI) indices, in order to diagnose early ventricular impairment in asymptomatic children and adolescence with the TI. MATERIALS AND METHODS We investigated possible differences in echocardiographic systolic and diastolic parameters between a population of 28 asymptomatic patients (mean age, 13.6 ± 5.7 years) and 35 age-matched healthy control members. All of them underwent 2-D, pulsed Doppler, and tissue Doppler echocardiographic studies for the assessment of the LV mass, Trans-mitral velocities, mitral annular systolic and diastolic velocities, myocardial performance index (MPI), and myocardial acceleration during isovolumic contraction (IVA). The cardiac iron load was estimated by magnetic resonance imaging T2*. RESULTS Left ventricular hypertrophy (LVH) was found in 13 (46.4%) patients. We found significantly reduced TDI-derived peak systolic myocardial velocity (s') in patients, whereas no significant difference was identified between the patients and control group members when the IVA was compared. The ratio of peak mitral inflow velocity to annular early diastolic velocity (E/e') of the mitral valve as an index of the diastolic function was significantly higher in patients (9 ± 1 vs. 6 ± 1, p < 0.05). Choosing a TDI-derived MPI > 0.33 as a cutoff point, the global LV dysfunction was detected with a sensitivity of 78% and a specificity of 80%. The patients with LVH significantly exhibited higher values of TDI-MPI and lower values of s' velocity and IVA when compared against the subjects with normal LV mass. CONCLUSION Subtle LV systolic and diastolic dysfunction develops early in young patients with the TI who have normal cardiac iron concentration. Moreover, LV remodeling as a main cardiac adaptive response plays a principal role in developing myocardial impairment.
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Affiliation(s)
- Roya Isa Tafreshi
- Department of Pediatric Cardiology, Ali Asghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Radgoodarzi
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kadijeh Arjmandi Rafsanjani
- Department of Pediatric Hematology and Oncology, Ali Asghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Soheilipour
- Department of Pediatric Endocrinology, Minimally Invasive Surgery Research Center, Aliasghar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Fernandes JMG, de Oliveira Romão B, Rivera IR, Mendonça MA, Costa FDA, Lira Handro MDS, Campos O, De Paola ÂAV, Moisés VA. Clinical value of myocardial performance index in patients with isolated diastolic dysfunction. Cardiovasc Ultrasound 2019; 17:17. [PMID: 31409406 PMCID: PMC6693095 DOI: 10.1186/s12947-019-0167-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/07/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS The Doppler-derived myocardial performance index (MPI) has been considered as a diagnostic and prognostic Doppler marker for many different clinical conditions. The purpose of this study was to determine the diagnostic accuracy of traditional Pulsed-wave Doppler (PWD-MPI) and Pulsed-wave tissue Doppler imaging (TDI-MPI) and the degree of agreement between these methods in patients with grade-I diastolic dysfunction (DDI) and a normal ejection fraction. METHODS Forty-seven consecutive ambulatory patients with DDI were compared to 51 healthy subjects with normal echocardiograms. All subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI. RESULTS TDI-MPI and PWD-MPI were significantly higher in patients with DDI than in control subjects: 0.49 ± 0.14 vs. 0.40 ± 0.09 (P < 0.001) and 0.45 ± 0.11 vs. 0.37 ± 0.08 (P < 0.001), respectively. Cutoff values of TDI-MPI > 0.42 and PWD-MPI > 0.40 identified DDI subjects, with sensitivities of 74 and 64%; specificities of 61 and 69%; positive likelihood ratios of 1.9 and 2.0; and negative likelihood ratios of 0.42 and 0.53, respectively; no significant difference was noted between the areas under the ROC curves of TDI-MPI and PWD-MPI (P = 0.77). Bland-Altman plots showed wide limits of agreement between these indices: - 0.17 to 0.23 in healthy subjects and - 0.24 to 0.32 in DDI patients. CONCLUSION PWD-MPI and TDI-MPI showed poor clinical agreement and were not reliable parameters for the assessment of left ventricular diastolic function.
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Affiliation(s)
- José Maria Gonçalves Fernandes
- Faculty of Medicine, Federal University of Alagoas, Av Lourival Melo Mota, sn, Tabuleiro dos Martins, Maceió, 57072-900, Brazil.
| | - Benício de Oliveira Romão
- Faculty of Medicine, Federal University of Alagoas, Av Lourival Melo Mota, sn, Tabuleiro dos Martins, Maceió, 57072-900, Brazil
| | - Ivan Romero Rivera
- Faculty of Medicine, Federal University of Alagoas, Av Lourival Melo Mota, sn, Tabuleiro dos Martins, Maceió, 57072-900, Brazil
| | - Maria Alayde Mendonça
- Faculty of Medicine, Federal University of Alagoas, Av Lourival Melo Mota, sn, Tabuleiro dos Martins, Maceió, 57072-900, Brazil
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Murase M. Assessing ventricular function in preterm infants using tissue Doppler imaging. Expert Rev Med Devices 2016; 13:325-38. [DOI: 10.1586/17434440.2016.1153966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sürücü H, Baytaroğlu C, Aksoy FA, Can N. Sürücü index and others. Indian Heart J 2015; 67:341-6. [PMID: 26304566 DOI: 10.1016/j.ihj.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/06/2015] [Accepted: 05/14/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In this study, we have aimed to evaluate the correlation between echocardiographic parameters that test systolic and diastolic function together. METHOD The study population was divided into two groups according to Vp. Group-1 (n = 103) represented the control group (Vp > 50 cm/s) and group-2 (n = 86) represented patients with systolic and diastolic dysfunctions together (Vp ≤ 50 cm/s). The echocardiographic parameters that evaluate systolic and diastolic function together, such as the Tei and the Sürücü indices, were compared between the groups. RESULTS In group-2, the Tei index was higher (p = 0.001) and the Sürücü index was lower (p < 0.001). We also showed that the Tei and Sürücü indices were significantly and negatively correlated. That is, as the Sürücü index decreases, the Tei index increases (p = 0.001). CONCLUSION Vp is an index more affected by diastolic parameters but rarely by systolic parameters because it is measured at diastolic period. The Tei index, on the other hand, is affected by preload variables and needs two different heart cycles for calculation. The Modified Tei index, however, has limited diagnostic value because of high inter-observer variability. In this study, the usability of the Sürücü index is shown in comparison with other indices used for this purpose. Considering that it is less affected by preload variables, can be calculated over a single heart cycle, and has the ability to test variables of both systolic and diastolic periods unlike Vp. We postulate that the Sürücü index is more usable and reliable.
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Affiliation(s)
- Hüseyin Sürücü
- Private Avcılar Hospital, Cardiology Department, İstanbul, Turkey.
| | - Corç Baytaroğlu
- Private Avcılar Hospital, Cardiology Department, İstanbul, Turkey
| | - Faik Alper Aksoy
- Private Medilife Hospital, Cardiology Department, İstanbul, Turkey
| | - Naser Can
- Private Avcılar Anadolu Hospital, Cardiology Department, İstanbul, Turkey
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Gerede DM, Turhan S, Kaya CT, Ozcan OU, Goksuluk H, Vurgun VK, Dincer I, Kutlay S, Erturk S, Erol C. Effects of Hemodialysis on Tei Index: Comparison between Flow Doppler and Tissue Doppler Imaging. Echocardiography 2015; 32:1520-6. [DOI: 10.1111/echo.12895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Sibel Turhan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Cansin Tulunay Kaya
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Ozgur Ulas Ozcan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Huseyin Goksuluk
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Veysel Kutay Vurgun
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Irem Dincer
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Sim Kutlay
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Sehsuvar Erturk
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Cetin Erol
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
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Gurrala RR, Alla VM, Aronow WS, Shankar JS, Angamutta MK, Lanka K, Challa S, Nair CK. Occult left ventricular dysfunction diagnosed by myocardial performance index in patients with limb girdle muscle dystrophy: A case control study. Int J Angiol 2012; 16:139-42. [PMID: 22477330 DOI: 10.1055/s-0031-1278268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The myocardial performance index (MPI) was assessed in 30 patients with limb girdle muscle dystrophy (LGMD) with a normal left ventricular ejection fraction (greater than 50%), as well as in 30 age- and sex-matched healthy adults with a left ventricular ejection fraction greater than 50%. MPIs derived by pulsed-wave Doppler and tissue Doppler were also compared. The MPI was 0.37±0.09 in the LGMD patients and 0.29±0.09 in the control group (P=0.003). These data show that patients with LGMD have occult cardiac dysfunction as evidenced by a higher MPI than the controls. There was good agreement between the MPIs measured by pulsed-wave Doppler and tissue Doppler methods in these patients.
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Affiliation(s)
- Rajashekar R Gurrala
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India
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Kiani A, Shabanian R, Seifirad S, Heidari-Bateni G, Rekabi M, Shahbaznejad L, Dastmalchi R, Kocharian A. The Impact of Preload Alteration on the Myocardial Performance Index through Implementing Positive End Expiratory Pressure. Echocardiography 2012; 29:900-5. [DOI: 10.1111/j.1540-8175.2012.01742.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hanaoka M, Kogashi K, Droma Y, Urushihata K, Kubo K. Myocardial performance index in subjects susceptible to high-altitude pulmonary edema. Intern Med 2011; 50:2967-73. [PMID: 22185987 DOI: 10.2169/internalmedicine.50.5942] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE A recent study concerning high-altitude pulmonary edema (HAPE), a non-cardiogenic pulmonary edema, suggested that it is initially a hydrostatic-type pulmonary edema. We suspect that some extent of cardiac insufficiency may likely relate to the mechanism of the development of this disease. METHODS By Doppler echocardiography, the Tei index (a new quantitative index proposed for the evaluation of global myocardial performance) and the systolic pulmonary artery pressure (sPAP) were measured before and after 30 minutes of hypoxic breathing. PATIENTS Eleven HAPE-susceptible subjects (HAPE-s) and nine HAPE-resistant subjects (HAPE-r). RESULTS The results of Tei index indicated an enhanced left myocardial performance but an impaired right performance in HAPE-s during hypoxic breathing. The sPAP of HAPE-s was significantly increased after hypoxic breathing, which was not correlated with the heart functions such as right ventricular (RV) Tei index, cardiac index (CI), percent ejection fraction (EF%) and percent fractional shortening (FS%) under hypoxic condition. Comparatively, the HAPE-r subjects did not show such significant changes of Tei index after hypoxic breathing. The results suggested that a paradoxical myocardial performance, in a format of an augmented left ventricular (LV) in contrast to an attenuated RV, was observed in the HAPE-s exposed to acute hypoxia. CONCLUSION The responses of the left and right myocardial performances to hypoxia may be involved in the pathogenesis of HAPE.
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Affiliation(s)
- Masayuki Hanaoka
- The First Department of Medicine, Shinshu University School of Medicine, Japan.
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9
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Tafreshi RI, Human N, Otukesh H, Nikavar A. Evaluation of Combined Left Ventricular Function using the Myocardial Performance Index in Children with Chronic Kidney Disease. Echocardiography 2010; 28:97-103. [DOI: 10.1111/j.1540-8175.2010.01249.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Choi JO, Choi JH, Lee HJ, Noh HJ, Huh J, Kang IS, Lee HJ, Lee SC, Kim DK, Park SW. Dual pulsed-wave Doppler tracing of right ventricular inflow and outflow: single cardiac cycle right ventricular tei index and evaluation of right ventricular function. Korean Circ J 2010; 40:391-8. [PMID: 20830253 PMCID: PMC2933464 DOI: 10.4070/kcj.2010.40.8.391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/19/2010] [Accepted: 03/10/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The reliability and usefulness of the right ventricular (RV) Tei index (RTX) remains controversial because it has not been possible to simultaneously measure RV inflow and outflow. However, dual pulsed-wave Doppler (DPD) enables flow velocities to be obtained at different sampling sites simultaneously. In this study we evaluated the feasibility and reliability of RTX values obtained by DPD (RTX(DPD)). SUBJECTS AND METHODS Forty-one patients who underwent cardiac catheterization and echocardiography for RV volume or pressure overloading conditions were evaluated. Symptom-limited exercise treadmill testing with expired gas analysis was performed and maximal exercise capacity was measured. RESULTS RTX by conventional flow Doppler (RTX(CFD), 0.262±0.164) was similar to RTX(DPD) (0.253±0.117, p=NS), whereas RTX by tissue Doppler echocardiography (RTX(TDE), 0.447±0.125) was significantly larger than RTX(DPD) (p<0.001). Based on multiple regression analysis, maximal exercise capacity was independently related to RTX(DPD) (β=-0.60, p<0.001), mid-RV dimension (β=-0.26, p=0.012), left ventricular ejection fraction (β=0.22, p=0.023), and early diastolic tricuspid annular velocity (β=0.21, p=0.048). CONCLUSION It is feasible and reliable to evaluate RV function using RTX(DPD) values. However, to evaluate the clinical usefulness of RTX(DPD), additional studies are required with a large number of patients and long-term follow-up.
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Affiliation(s)
- Jin-Oh Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Kargin R, Kargin F, Mutlu H, Emiroglu Y, Pala S, Akcakoyun M, Aung SM, Baran R, Ozdemir N. Long-term exposure to biomass fuel and its relation to systolic and diastolic biventricular performance in addition to obstructive and restrictive lung diseases. Echocardiography 2010; 28:52-61. [PMID: 20738366 DOI: 10.1111/j.1540-8175.2010.01278.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated an increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However, biventricular heart function has yet to be investigated in these patients. Left ventricular (LV) myocardial performance index (LVMPI), which is an index of global ventricular function, incorporates ejection, isovolumic relaxation, and contraction times. In this study, pulmonary function and biventricular heart function were investigated in nonsmoking female patients with BFE. METHODS Our study population consisted of 46 female patients with BFE (group 1) and 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular myocardial performance index (RVMPI) and LVMPI were obtained by tissue Doppler imaging echocardiography (TDI). RESULTS BFE caused obstructive and restrictive spirometric impairments. RVMPI was higher in group 1 (0.55 ± 0.07) than group 2 (0.46 ± 0.06) (P = 0.042) and LVMPI was higher in group 1 (0.54 ± 0.08) than group 2 (0.47 ± 0.05) (P = 0.032). Also, pulmonary artery systolic pressure was higher in group 1 than group 2 (P = 0.02). CONCLUSIONS BFE causes both obstructive and/or restrictive lung disease and systolic and diastolic biventricular dysfunction. Nonetheless, long-term studies are needed to understand on BFE-related ventricular dysfunctions and to document subsequent cardiovascular events.
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Affiliation(s)
- Ramazan Kargin
- Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital, Istanbul, Turkey.
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Amoozgar H, Mehdizadeh S, Ajami G, Alyasin S, Borzoee M, Abtahi S, Cheriki S. Evaluation of myocardial function by pulsed tissue Doppler in Kawasaki disease. Pediatr Cardiol 2009; 30:936-40. [PMID: 19533214 DOI: 10.1007/s00246-009-9466-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 04/13/2009] [Accepted: 04/27/2009] [Indexed: 11/28/2022]
Abstract
Myocarditis is a well-recognized component of Kawasaki disease, with left ventricular dysfunction occurring in more than half of patients during the acute phase. The purpose of this study was to evaluate myocardial function in patients with Kawasaki disease using pulsed tissue Doppler imaging (TDI). Twenty-five patients with the diagnosis of acute Kawasaki disease were enrolled in the study. All patients underwent echocardiographic studies at the time of diagnosis of the disease, in its acute phase, prior to treatment, and then 4 weeks later. For an aged-matched control group with fever and no cardiac disease, the same echocardiographic evaluations were performed. Peak velocities of systolic (Sa), early diastolic (Ea), and late diastolic (Aa) motion of the annulus were obtained at the lateral and septal sides in apical four-chamber view, and TDI-derived myocardial performance index (TDI-MPI) was also calculated. Peak Ea velocity of lateral mitral annulus was decreased significantly during the acute phase of illness (14 +/- 4.40 vs. 17.67 +/- 4.41; P = 0.028). In seven patients with carditis, changes in Ea-to-Aa ratio of septum (1.28 +/- 0.278 vs. 1.78 +/- 0.49; P = 0.018) and lateral mitral annulus (1.23 +/- 0.496 vs. 2.11 +/- 0.822; P = 0.014) were statistically significant but TDI-MPI showed no statistically significant changes. This study showed that peak mitral annular Ea velocities obtained by TDI were significantly altered in the acute phase of Kawasaki disease. TDI- MPI does not add an incremental benefit to other indexes of myocardial performance for comprehensive myocardial function in the acute phase of Kawasaki disease.
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Affiliation(s)
- Hamid Amoozgar
- Division of Pediatric Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
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Doppler myocardial performance index in assessment of ventricular function in children with single ventricles. World J Pediatr 2008; 4:109-13. [PMID: 18661765 DOI: 10.1007/s12519-008-0021-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Quantitative assessment of ventricular function in children with single ventricles is both difficult and subjective because of asymmetric ventricular geometry. The Doppler myocardial performance index (MPI) allows the assessment regardless of ventricular shape. This study was designed to evaluate the feasibility of MPI in assessing ventricular function in children with single ventricles before and after total cavopulmonary connection (TCPC). METHODS Subjects consisted of 161 pediatric patients with single ventricles and 80 normal children without heart disease. The maximum positive rate of ventricular pressure change (Max dp/dt) was obtained in 58 patients by cardiac catheterization. Sixty-eight children with single ventricles received TCPC. MPI was calculated from Doppler tracings of ventricular inflow and outflow, then MPI of single ventricles before and after surgery and normal heart were compared. RESULTS Normal MPI value was 0.30+/-0.08 in the left ventricle and 0.26+/-0.08 in the right ventricle. Compared to normal children, MPI was significantly higher in 161 children with single ventricles (0.54+/-0.11, P<0.001). MPI correlated inversely with Max (dp/dt) (r=-0.77, P<0.01), and was positively related to age (r=0.54, P<0.01) in patients with single ventricles. MPI did not differ significantly before and after surgery in 68 patients with single ventricles (0.55+/-0.21 vs 0.51+/-0.20, P>0.05). However, MPI in 48 patients of <6 years old decreased significantly (0.55+/-0.21 vs 0.48+/-0.18, P<0.05), suggesting improved ventricular function. CONCLUSIONS Compared to normal children, ventricular function is impaired in patients with single ventricles and may worsen with age. MPI provides an accurate method for assessing ventricular function in children with single ventricles before and after TCPC.
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Acharya G, Pavlovic M, Ewing L, Nollmann D, Leshko J, Huhta JC. Comparison between pulsed-wave Doppler- and tissue Doppler-derived Tei indices in fetuses with and without congenital heart disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:406-411. [PMID: 18340627 DOI: 10.1002/uog.5292] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The aim of this study was to compare the right (RV) and left (LV) ventricular Tei indices obtained by pulsed-wave Doppler (PD) and tissue Doppler (TD) methods in fetuses with structurally normal and abnormal hearts. METHODS This was a retrospective cross-sectional study of 147 fetuses that had a fetal echocardiogram and Tei index measured during a 2-year period. The RV and LV Tei indices were measured using both PD and TD methods. The difference between the two methods of Tei index measurement was tested using paired sample t-test, Pearson correlation coefficient was used to examine their relationship, and the agreement between the methods was tested using Bland-Altman analysis. RESULTS A total of 87 fetuses had normal hearts and 60 had a congenital heart defect. Both PD and TD Tei indices were measured successfully from at least one ventricle in 123 cases and from both ventricles in 110 cases. The mean TD Tei index was significantly higher than the mean PD Tei index for both ventricles (P < 0.0001). There was a weak but statistically significant correlation between the PD and TD Tei indices of the right ventricle (r = 0.20, P = 0.029), whereas the PD and TD Tei indices of the left ventricle did not correlate significantly (r = 0.04, P = 0.684). When pairs of Tei indices measured by two different methods (123 pairs for the right ventricle and 111 for the left ventricle) were tested with Bland-Altman analysis, the bias and precision were 0.147 and 0.254, respectively, for the right ventricle, and 0.299 and 0.276, respectively, for the left ventricle. CONCLUSIONS Correlation between Tei indices measured by PD and TD methods is weak and the agreement between individual measurements is poor. Therefore, they should not be used interchangeably in the assessment of fetal cardiac function.
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Affiliation(s)
- G Acharya
- Department of Pediatrics, University of South Florida College of Medicine and All Children's Hospital, Children's Research Institute, St Petersburg, FL 33701, USA.
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Hori Y, Kunihiro SI, Hoshi F, Higuchi SI. Comparison of the myocardial performance index derived by use of pulsed Doppler echocardiography and tissue Doppler imaging in dogs with volume overload. Am J Vet Res 2008; 68:1177-82. [PMID: 17975971 DOI: 10.2460/ajvr.68.11.1177] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship between the myocardial performance index (MPI) determined by use of pulsed Doppler (PD) echocardiography and tissue Doppler imaging (TDI) in the response to volume overload-related changes in left ventricle (LV) performance. ANIMALS 7 male Beagles. PROCEDURES Dogs were anesthetized and intubated. A 6-F fluid-filled catheter was placed in the LV to measure LV peak systolic (LVPs) and LV end-diastolic (LVED) pressures. Preload was increased by IV infusion of lactated Ringer's solution (rate of 200 mL/kg/h for 60 minutes) into a cephalic vein. Transmitral flow velocities and aortic outflow were measured, and TDI velocities were obtained from the 4-chamber view. RESULTS Acute volume overload induced a significant increase in heart rate, LVPs pressure, and LVED pressure, compared with baseline values. A significant decrease in the PD-MPI and TDI-MPI values and a significant correlation (r = 0.70) between PD-MPI and TDI-MPI were detected. The PD-derived A-wave velocity, ejection time, and isovolumic relaxation time (IRT) and the TDI-derived IRT, MPI, and ratio of the velocity of the E wave to the velocity of the ventricular portion of the E wave during early diastole had equal ability to predict LVED pressure (r(2) = 0.63). CONCLUSIONS AND CLINICAL RELEVANCE The TDI-MPI was closely correlated with LV filling pressure and may be helpful in evaluating global cardiac function in dogs.
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Affiliation(s)
- Yasutomo Hori
- Department of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, 23-35-1 Higashi, Towada, Aomori 034-8628, Japan
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Chang SM, Lin CC, Hsiao SH, Lee CY, Yang SH, Lin SK, Huang WC. Pulmonary Hypertension and Left Heart Function: Insights from Tissue Doppler Imaging and Myocardial Performance Index. Echocardiography 2007; 24:366-73. [PMID: 17381645 DOI: 10.1111/j.1540-8175.2007.00405.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND As a consequence of a leftward shift of the interventricular septum and of pericardial restraint, related to the degree RV dilatation, left heart function would be influenced after pulmonary hypertension and right heart failure. METHODS AND RESULTS We enrolled 70 patients with pulmonary artery systolic pressure (PASP) more than 30 mmHg: 40 patients with PASP between 30 and 60 mmHg (Group 2), 30 patients with PASP more than 60 mmHg (Group 3). Another 70 patients with normal heart performance and PASP less than 30 mmHg served as the control group (Group 1). Myocardial performance index (MPI), isovolumic contraction time (IVCT), and isovolumic relaxation time (IVRT) were obtained by tissue Doppler imaging (TDI). PASP correlated negatively to peak systolic velocity of lateral tricuspid annulus (RV-Sm) and RVEF. The MPI of RV and LV in patients with severe pulmonary hypertension (Group 3) became higher as the result of the prolongation of IVRT. The higher E/Em (peak early-diastolic mitral-inflow velocity divided by early-diastolic velocity of mitral annulus) in pulmonary hypertension indicated diastolic dysfunction of LV. The decline of left ventricular ejection fraction, and also right ventricular ejection fraction, suggested LV systolic dysfunction after pulmonary hypertension. The LV-MPI truly reflected LV systolic and diastolic dysfunction in patients with pulmonary hypertension. In multiple linear regression analysis, LV-MPI was independently associated only with RV-MPI (Beta 0.47, P < 0.0001). CONCLUSION The result infers that the systolic and diastolic function of LV declined, following pulmonary hypertension.
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MESH Headings
- Adult
- Aged
- Analysis of Variance
- Blood Flow Velocity
- Case-Control Studies
- Echocardiography, Doppler, Pulsed
- Heart Rate
- Heart Septum/diagnostic imaging
- Heart Septum/physiopathology
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnostic imaging
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/physiopathology
- Linear Models
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/physiopathology
- Myocardial Contraction
- Observer Variation
- Pulmonary Wedge Pressure
- Research Design
- Severity of Illness Index
- Stroke Volume
- Tricuspid Valve/diagnostic imaging
- Tricuspid Valve/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/epidemiology
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Shu-Mei Chang
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan, R.O.C
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Abstract
PURPOSE OF REVIEW We review new findings concerning ventricular function in patients in intensive care units with shock or unexplained respiratory distress syndrome analyzed using echocardiography. RECENT FINDINGS Bedside echocardiography is not only an imaging technique but should be considered as a hemodynamic method. Left-ventricular systolic function can be assessed in daily clinical practice by measuring shortening fraction, fraction area change and ejection fraction. But these indices are dependent on load conditions. Index of myocardial performance can be also used. Rate of left-ventricular pressure increase may be measured from mitral regurgitation. Other indices such a maximal elastance and preload-adjusted maximal power were developed to evaluate myocardial systolic function but are not still used in clinical practice in patients in intensive care. Cardiac output measurement can be calculated easily from aortic annulus diameter and the velocity time integral of aortic blood flow. To complete the assessment of ventricular function, left-ventricular diastolic function and pressure as well as right ventricular size, septal movement and right pressures should be analyzed. SUMMARY Using echocardiography the intensivist can examine both the mechanism and the cause of shock or pulmonary edema. It is time to increase the use of this technique in intensive care units.
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Affiliation(s)
- Michel Slama
- INSERM, ERI 12, Amiens, France and unite de reanimation, service de nephrologie, CHU sud Amiens, France.
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18
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Norozi K, Buchhorn R, Bartmus D, Alpers V, Arnhold JO, Schoof S, Zoege M, Binder L, Geyer S, Wessel A. Elevated brain natriuretic peptide and reduced exercise capacity in adult patients operated on for tetralogy of fallot is due to biventricular dysfunction as determined by the myocardial performance index. Am J Cardiol 2006; 97:1377-82. [PMID: 16635615 DOI: 10.1016/j.amjcard.2005.11.057] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 11/21/2005] [Accepted: 11/21/2005] [Indexed: 11/17/2022]
Abstract
Although tetralogy of Fallot (TOF) can be repaired surgically, residual lesions that cause abnormal ventricular load can eventually lead to heart failure. Subclinical biventricular dysfunction in these patients may be detected only by using suitably sensitive indexes. The Tei index determined by the pulsed Doppler method enables the measurement of left ventricular (LV) and right ventricular (RV) function. This study was designed to evaluate the biventricular Tei indexes in adults with operated congenital heart disease and to correlate these indexes with cardiopulmonary capacity and neurohormonal activation. Fifty-nine patients with surgically corrected TOF and 52 patients with operated left-to-right-shunt defects were included in the study. Patients with TOF showed significantly greater LV and RV Tei indexes than those with left-to-right-shunt defects (LV Tei index 0.50 +/- 0.09 vs 0.34 +/- 0.05, RV Tei index 0.37 +/- 0.1 vs 0.25 +/- 0.06; p <0.0001). Peak oxygen uptake was significantly reduced in the patients with TOF (25 +/- 6 vs 32 +/- 6 ml x kg(-1) x min(-1), p <0.0001) and was correlated inversely with the LV Tei index (r = -0.61, p <0.0001). N-terminal-pro-brain natriuretic peptide was significantly increased in patients with TOF (150 +/- 141 vs 57 +/- 39 pg/ml, p <0.0001). In conclusion, in asymptomatic or minimally symptomatic patients with TOF, biventricular dysfunction is detected by the Tei index. Further indexes for heart failure in these patients are increased circulating plasma N-terminal-pro-brain natriuretic peptide and impaired peak oxygen uptake. The combined determinations of these 3 variables enable the identification of congenital heart disease with impaired cardiac function before they become clinically symptomatic.
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Affiliation(s)
- Kambiz Norozi
- Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany.
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Su HM, Lin TH, Voon WC, Lee KT, Chu CS, Lai WT, Sheu SH. Differentiation of Left Ventricular Diastolic Dysfunction, Identification of Pseudonormal/Restrictive Mitral Inflow Pattern and Determination of Left Ventricular Filling Pressure by Tei Index Obtained from Tissue Doppler Echocardiography. Echocardiography 2006; 23:287-94. [PMID: 16640705 DOI: 10.1111/j.1540-8175.2006.00222.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Tei index obtained from tissue Doppler echocardiography (TDE-Tei index) has an inherent advantage of recording its systolic and diastolic components simultaneously on the same cardiac cycle. The aims of this study are to evaluate whether TDE-Tei index also exerts a correlation with left ventricular (LV) systolic and diastolic function and filling pressure and to see whether it can effectively identify the pseudonormal/restrictive mitral filling pattern. METHODS Echocardiographic examination was performed in 243 consecutive patients. These patients were classified into three groups as normal, abnormal relaxation, and pseudonormal/restrictive groups according to the transmitral E/A-wave velocity (E/A), early diastolic velocity of lateral mitral annulus (Ea) and E/Ea. RESULTS Standard Doppler indices of LV filling such as E, A, E/A, and E-wave deceleration time had a bimodal distribution, but Ea decreased and E/Ea and TDE-Tei index increased progressively with worsening of LV diastolic function. The sensitivity and specificity of TDE-Tei index>0.51 in the discrimination of pseudonormal/restrictive filling pattern were 85% and 96%, respectively. After stepwise multiple linear regression analysis, TDE-Tei index had a significant negative correlation with Ea (beta=-0.296, P<0.001) and ejection fraction (beta=-0.293, P<0.001) and positive correlation with E/Ea (beta=0.235, P=0.001). CONCLUSIONS TDE-Tei index increased with worsening of LV diastolic function and can effectively identify the pseudonormal/restrictive mitral inflow pattern. It also correlated with the echocardiographic parameters of LV systolic and diastolic function and filling pressure. It suggests that TDE-Tei index is a simple and feasible marker in assessing global LV function.
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Affiliation(s)
- Ho-Ming Su
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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Kim HJ, Cha JH, Hong YM. Modified Tei index in patients with Kawasaki disease by tissue doppler imaging. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.11.1202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hee Jung Kim
- Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Jung Hwa Cha
- Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
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