Bruch C, Schmermund A, Marin D, Katz M, Bartel T, Schaar J, Erbel R
Department of Cardiology, University of Essen, Germany.
Eur Heart J. 2000 Nov;21(22):1888-95. doi: 10.1053/euhj.2000.2246.
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.
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 >/=16 mmHg (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+/-3 mmHg) 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+/-42 ms vs 206+/-36 ms, P=ns) and isovolumic relaxation time (97+/-16 ms vs 94+/-26 ms, 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).
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.
充血性心力衰竭与心室收缩和舒张异常有关。单独分析任何一种机制可能都无法反映整体心脏功能障碍。一种综合心肌性能指数（等容收缩时间加等容舒张时间除以射血时间，即“Tei指数”）已被描述，它可能比单独的收缩期和舒张期测量方法更有效地分析整体心脏功能障碍。本研究的目的是对照侵入性检查评估Tei指数。
连续纳入81名受试者，他们来自125名接受左心导管检查以有创测量左心室舒张末期压力的患者；43例患者患有充血性心力衰竭（35例男性，8例女性，68±6岁），根据纽约心脏协会（NYHA）功能分级≥2级（平均2.5±0.5）且左心室舒张末期压力≥16 mmHg（平均20±4）定义，38名受试者（32例男性，6例女性，66±5岁）无心力衰竭症状（NYHA功能分级I级）且左心室舒张末期压力正常（平均12±3 mmHg）作为对照组。使用传统的超声多普勒方法，评估的参数包括：射血分数、舒张早期（E）和晚期（A）充盈峰值速度、E/A比值、减速时间、等容收缩时间、等容舒张时间和射血时间。Tei指数通过从二尖瓣血流停止到开始的间隔时间中减去射血时间获得。对照组和充血性心力衰竭患者在E/A比值（0.86±0.27对0.90±0.
