Tei Index Is the Best Echocardiographic Parameter for Assessing Right Ventricle Function in Patients With Unrepaired Congenital Heart Diseases With Outflow Tract Obstruction

Abstract

Objective: Magnetic resonance imaging (MRI) and cardiac catheterization are diagnostic tools for right ventricle dysfunction (RVD), but those are expensive and often unavailable techniques. Thus, our objective was to identify clinical and/or echocardiographic variables capable of predicting a catheterization-based diagnosis of RVD.Design: This was cross-sectional, diagnostic test accuracy study, considering the catheterization-based diagnosis of RVD as the gold standard.Patients: Pediatric patients with non-repaired CHD with overload pressure were evaluated. Clinical variables (edema and functional class), transthoracic echocardiography (right heart dimensions, systolic and diastolic function, Doppler velocities), and cardiac catheterization (pressures and right ventricle systolic work measurements) were obtained during the same hospitalization.Results: We included 253 patients with tetralogy of Fallot (39.9%), pulmonary atresia with ventricular septal defect (33.9%), type C Ebstein's anomaly (15.8%), or pulmonary stenosis (10.4%). Among clinical (vascular congestion, functional class derangement) and echocardiographic (indexed right ventricle diameter, fractional area change, tricuspid annular plane systolic excursion, S' wave, Tei index) variables, the Tei index (defined as the ratio of isovolumetric contraction time to ejection time) was the sole variable that exhibited high diagnostic capability, with 98.5% sensitivity, 97.4% specificity, 97.8% positive predictive value, and 98.3% negative predictive value, with 98.0% overall performance. Multivariate logistic regression confirmed that Tei index alone predicted the catheterization-based diagnosis of RVD.Conclusions: Tei index is the best parameter that can be employed for the non-invasive identification of RVD in patients with CHD.

Speckle‐Tracking Analysis in Fetuses With Tetralogy of Fallot: Evaluation of Right and Left Ventricular Contractility and Left Ventricular Function

“…11 The measurements used in their study were similar to our approach and demonstrated the following sensitivity and specificity for predicting RV dysfunction: 1) RV fractional area change, 65.9%, 66.7%; and 2) tricuspid annular plane systolic excursion, 70.5%, 78.9%. 11 In 2019, Bao and colleagues evaluated the RV function in 37 children who had undergone surgical repair for TOF, with a mean age of 8 years 6 months. 12 They compared the ejection fraction using cardiac magnetic resonance imaging with ultrasound-measured RV fractional area change, RV annular plane systolic excursion, and speckle-tracking analysis of the RV free wall, and found significant correlations between magnetic resonance-measured ejection fraction and ultrasoundmeasured fractional area change and free wall speckle-tracking strain analysis.…”

“…Postnatal evaluation of cardiac function in children with TOF has used several techniques described in the current study. In 2018, Marquez‐Gonzalez evaluated RV dysfunction in children with TOF at a mean age 7 years 2 months 11 . The measurements used in their study were similar to our approach and demonstrated the following sensitivity and specificity for predicting RV dysfunction: 1) RV fractional area change, 65.9%, 66.7%; and 2) tricuspid annular plane systolic excursion, 70.5%, 78.9% 11 .…”

“…In 2018, Marquez‐Gonzalez evaluated RV dysfunction in children with TOF at a mean age 7 years 2 months 11 . The measurements used in their study were similar to our approach and demonstrated the following sensitivity and specificity for predicting RV dysfunction: 1) RV fractional area change, 65.9%, 66.7%; and 2) tricuspid annular plane systolic excursion, 70.5%, 78.9% 11 . In 2019, Bao and colleagues evaluated the RV function in 37 children who had undergone surgical repair for TOF, with a mean age of 8 years 6 months 12 .…”

Application and clinical significance of tissue ultrasound for assessment of right ventricular diastolic function in patients with coronary slow flow

“…The Tei index, first proposed in 1995, evaluates the systolic and diastolic function of the heart. 17 It is the ratio of the sum of the isovolumic systolic interval and the isovolumic diastolic interval to the ejection time of the heart, and thus can directly reflect the overall function of the right ventricle and accurately evaluate right ventricular function. Indeed, studies have shown that among clinical (vascular congestion, functional grade disorder) and echocardiographic (index, right ventricular diameter, area fraction change, tricuspid annular plane systolic shift, S wave, Tei index) variables, Tei index was the only variable with high diagnostic ability.…”

Myocardial performance index and cardiovascular diseases

“…In summary, the Tei index is a noninvasive echocardiographic parameter that can provide valuable information on the overall function of the heart, including in patients with CHD. The Tei index can be used to assess cardiac function, predict outcomes, and guide management in these patients 16 …”