Background: The MPI is a composite measurement of systolic and diastolic dysfunction that has demonstrate the predict congestive heart failure. This study was correlated the myocardial performance (TEI) index and LV function by Simpsons method in EF <35% patients and to evaluate its efficiency by echocardiography. Method: The myocardial performance is obtained by measuring IVRT, IVCT, ET using pulse wave doppler and LV function is assessed using Simpsons method in apical 4 chamber view using GE VIVID S5 and ESAOTE. Result: The myocardial performance functional parameters were significantly correlating with LV function value of EF <35% patients. Conclusion: MPI is a sensitive indication of total cardiac dysfunction in patients with congestive heart failure.
The MPI is also known as the Tei index, it has a extensively study in literature to prognostic and progressive marker for a number of cardiac conditions (1,2,3). Even in patients who do not exhibit symptoms, DD identified by doppler to separate the risk factors for heart failure and all-cause death (4). While there are several traditional indices for assessing diastolic function, including TDI, DT, transmitral doppler wave pattern and IVRT, and they also indicates the several evaluation of systolic function, including EF, CO, cardiac index and FS. Few studies have been reported on isolated LV diastolic dysfunction (5,6,7). MPI is calculated using the PWD imaging – derived MPI. This method has a high diagnostic accuracy for people with HF and LV dysfunction since it permits the simultaneous measurement of diastolic and systolic duration in same cardiac cycle (8,9,10). The aim of present study was the correlation of myocardial performance (TEI index) and the LV function by Simpson’s method in persons with LV dysfunction.
Our investigation is prospective observational study and it was carried out in kelambakam, at Chettinad super speciality hospital. 100 patients were totally included in this study. Patients were progressively chosen from our hospital’s echocardiography laboratory. Full echocardiography performed on them, encompassing Doppler, M-mode and 2D echocardiography. This investigation has been approved by IHEC. INCLUSION CRITERIA: Both sex, dilated cardiomyopathy, heart failure, ischemic heart disease, patients with EF <35%. EXCLUSION CRITERIA: Patient under the age of 18, normal LV function, patient with EF >35%.
Echocardiography:
Transthoracic echocardiographic was performed on each individual accordance to the guidelines recommended by the ASE and it has been performed (with Esoate and Vivid S5, GE medical system) using commercially available equipment. A3-5 MHz transducer was used to obtain PLAX, PSAX and Apical views were used in this study and the left lateral decubitus position has been done.
Measurements were made of LV function, Fractional shortening and EF were applied to Simpson’s rule. Assessment of LV systolic function with echocardiography in EF, is determined by 2dimensional echocardiography. It is obtained from apical views which includes EDV, ESV and EF. The apical four chamber view using PWD imaging, between the aortic valve, IVRT, IVCT and ET were measured.
Systolic and diastolic functions are both reflected to Tei index. The definition was given as the sum of IVRT and IVCT divided by the ET derived from the LV inflow and outflow (11).
Statistical Analysis:
Analysis of the data was done with IBM SPSS version 26. Correlations were calculated using Pearsons, the Chi-Square test and the unpaired t-test. The differences in categorical variables between multiple groups were compared using the chi-square test. To compare two independent populations of appropriately distributed data, the independent t-test was employed.
Patient Demography:
In this prospective and observational study, a total of 100 patients, among them 71 are male 29 are female patients.
Table 1: Classification Of Gender Distribution:
Among 100 patients 56 patients were diagnosed to have moderate LV dysfunction, 44 were to have severe LV dysfunction.
Among 56 patients of moderate LV 16 patients were females (29%), 40 patients were males (71%)
Among 44 patients of severe LV 13 patients were females (30%), 31 patients were males (70%).
|
TOTAL |
|
NO |
% |
MODERATE |
56 |
FEMALE |
16 |
29% |
MALE |
40 |
71% |
||
SEVERE |
44 |
FEMALE |
13 |
30% |
MALE |
31 |
70% |
Table 2: Correlation Between IVRT And LVEF:
IVRT & EF |
|
PEARSON "r" |
-0.46025 |
P value |
1.451eˉ⁰⁰⁶ |
Table 2 shows that IVRT is negatively correlated with LVEF. There is a significant correlation of IVRT and LVEF.
Table 3: Correlation Between IVCT and LVEF:
IVCT & EF |
|
PEARSON "r" |
-0.42661 |
P value |
9.603eˉ⁰⁰⁶ |
Table 3 showed a positive correlation with IVCT & LVEF. There is significant correlation of IVCT and LVEF.
Table 4: Correlation Between ET AND LVEF:
ET & EF |
|
PEARSON "r" |
0.84153 |
P value |
2.938eˉ⁰²⁸ |
Table 4 shows that ET is positively correlated with LVEF. There is significant correlation of ET and LVEF.
Table 5: Correlation Between MPI (TEI INDEX) and LVEF:
MPI & EF |
|
PEARSON "r" |
-0.9076 |
P value |
4.8994eˉ⁰³⁹ |
Table 5 showed a positive correlation with MPI & LVEF. There is significant correlation of MPI and LVEF.
Pearson r value lies between -1 to +1.
The present study shows that TEI index is a reliable and sensitive measure of general heart dysfunction. Current data are expressed as Pearson r value. IVRT is negatively correlated with EF. IVCT, ET and MPI are positively correlated with EF. The statistical relationships between TEI index and LV dysfunction were found to be significant.
It has been demonstrated that diastolic and systolic function are connected to left ventricular pattern. (12) The suggested parameter which has been associates the pulmonary capillary wedge pressure and IVRT ratio and the time interval between the start of an E and an E-wave (r=0.74, P<0.05) was correlated well (13), separate from the function of the mitral valve. (14) The Study has been demonstrated that, despite confounding variables, the Tei index is unaffected these and to provide the assessment of systolic and diastolic function in sizable portion of the population. (11,14,15) This work further supports previous research demonstrating the Tei index that can be unaffected by flow hemodynamics, preload, afterload, age and LV in a range of patients as well as children. (11,16,17,18)
There was no difference between the control group and discernible difference in the systolic components isovolumetric CT and ET. In isolated cases of LV diastolic dysfunction, IVRT tends to increase (19) because diastolic relaxation occurs earlier and more slowly. (20)
When patients have high filling pressure and moderate to severe congestive heart failure, the TEI index provides a sensitive measurement of cardiac dysfunction. From this study we found that myocardial performance is increased with decreased left ventricular function.