Detection of left ventricular dysfunction with Tei index in normal ejection fraction patients with mitral regurgitation before mitral valve surgery.

Ejection fraction (EF) was not considered a reliable parameter of left ventricular (LV) function and was normal in most patients with chronic mitral regurgitation (MR), whereas LV dysfunction expressed as decreased EF was often shown after mitral valve surgery. This study sought the ability of the Tei index to detect latent LV dysfunction in patients with MR and apparently normal EF. One hundred eight patients with apparently normal EF (EF > or =50%) and chronic severe MR who underwent mitral valve repair were investigated. EF was significantly decreased after surgery and LV dysfunction (EF <50%) was shown in 37 patients (34% of all patients). The preoperative Tei index significantly correlated with postoperative EF in all patients (r = -0.64, p <0.0001) and asymptomatic patients (n = 44; r = -0.57, p <0.0001). By setting the preoperative Tei index >0.5 to predict postoperative EF <50%, this index had sensitivity, specificity, and accuracy of 89%, 85%, and 86% in all patients and 80%, 85%, and 84% in asymptomatic patients, respectively. In conclusion, a preoperative Tei index >0.5 allowed prediction of postoperative LV dysfunction in patients with MR with apparently normal EF. Thus, earlier surgery is recommended in asymptomatic patients with MR with normal EF, but Tei index >0.5.