Is Myocardial Performance Index an Independent Echocardiographic Marker of Death in Children with Idiopathic Dilated Cardiomyopathy?

Abstract

Background: Myocardial performance index (MPI) was reported as a parameter of ventricular systolic and diastolic function, as well as a useful tool to predict the outcome in patients with ventricular dysfunction. Hypothesis: To compare MPI with classical echocardiographic parameters as an independent marker of death in children with idiopathic dilated cardiomyopathy (IDCM). Methods: Fifty-five children (13 deaths) underwent 104 echocardiograms from January 1996 to May 2005. Right ventricle (RV) MPI and left ventricle (LV) MPI, and 9 classical echocardiographic parameters (left atrium [LA]/body surface area [BSA], distance between mitral E point and ventricular septum, LV mass/body surface area, RV shortening fraction, LV end-systolic and end-diastolic dimensions/body surface area, LV ejection fraction, fiber circumferential shortening velocity, and mitral deceleration time) were compared. Statistical analysis was performed by chi-square, Pearson's correlation and Student t-test, Kaplan-Meier method, Cox's method, and receiver operating curve (ROC). Statistical significance was considered with α<0.05 and p = 0.80. Results: Univariate analysis showed that all studied parameters were markers of death. There was a high correlation between RVMPI and LVMPI (r = 0.847-p = 0.0001); therefore, to avoid bias, RVMPI was discharged from multivariate analysis. In the deceased group, moderate/severe mitral regurgitation was frequent (76.9%; confidence interval [CI] 95% = 46.2%-94.9%) and it was considered in multivariate analysis. In Cox's multivariate analysis, LVMPI was the only independent marker of death (p = 0.0213). The ideal cut-off was 0.63 with 92.3% sensitivity, 66.7% specificity, and fitted ROC area = 0.918. Conclusions: In children with IDCM, LVMPI is an independent marker of death.

Tissue Doppler Septal Tei Index Indicates Severity of Illness in Pediatric Patients With Congestive Heart Failure

“…It is an independent predictor of worsening outcomes in adult and pediatric patients with DCM[10-12]. In a study of 161 healthy children, the Doppler Tei index decreased until 3 years of age, after which it did not change[2].…”

“…Its original description utilized Doppler mitral valve inflow and aortic outflow velocities[9]. It has been reported as an indicator of adverse outcomes in pediatric and adult patients with dilated cardiomyopathy (DCM)[10-12]. With TDI, the Tei index can be determined from myocardial velocities despite limited 2-dimensional acoustic windows and may be more accurate in pediatric patients as it is less altered by heart rate variability[13].…”

Evaluation of Combined Left Ventricular Function using the Myocardial Performance Index in Children with Chronic Kidney Disease

“…MPI obtained from PWD method has been described as a noninvasive index reflecting combined LV function 10,22 . Several studies have shown the utility of PWD‐MPI as a reliable predictor of outcome in a variety of diseases 23,24 . Such results suggest that the early diagnosis of initial phase of heart failure using the PWD‐MPI could improve cardiovascular prognosis; this is becoming more important nowadays because of increased life span of children after renal transplantation.…”

Simvastatin provides long‐term improvement of left ventricular function and prevents cardiac fibrosis in muscular dystrophy

“…The utility of MPI has also been demonstrated in children with idiopathic dilated cardiomyopathy, where it was shown to be an independent, predictive measure of mortality (Azevedo et al. ). In mdx mice, an animal model of DMD, MPI is significantly increased by 12 months of age compared to WT mice, indicating left ventricular dysfunction (Adamo et al.…”