Usefulness of Tissue Doppler Imaging‐Myocardial Performance Index in the Evaluation of Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction

Abstract

Background: In heart failure with preserved ejection fraction (HFPEF), physiological abnormalities are not solely restricted to diastolic function. Because the tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) offers the advantage of recording systolic and diastolic tissue velocity simultaneously in the same cardiac cycle, this study aimed to determine whether TDI-MPI is an informative index for assessing HFPEF, compared with conventional echo parameters. Hypothesis: In patients with HFPEF, TDI-MPI would be an independent predictor for adverse cardiac events. Methods: Among 408 patients who had diastolic dysfunction without heart failure (HF) or HFPEF, cardiac function was evaluated by mitral flow (MF) or TDI-MPI. During the median follow-up of 32 months, clinical outcomes, which were defined as the composite of cardiovascular death and admission for HF, were assessed. Results: Mean MF and TDI-MPI were significantly greater in the HFPEF group. TDI-MPI rather than MF had a significant correlation with N-terminal pro-brain natriuretic peptide level. The area under the receiver operating characteristic curve of TDI-MPI for the detection of HFPEF was 0.86. With regard to clinical outcomes, 31 events were identified during follow-up periods. On a multivariate analysis, TDI-MPI >0.66 was the best prognostic predictor of events and provided incremental predictive value. Conclusions: Compared to MF-MPI, TDI-MPI may be a more useful parameter for the evaluation of patients with HFPEF.

Prognostic value of cardiac time intervals measured by tissue Doppler imaging M-mode in the general population

“…These differences may also explain why the MPI obtained by the TDI M-mode method is more precise and has better reproducibility 1 12. In accordance with this, MPI obtained by using the regional TDI velocity curves18 19 has also demonstrated to be superior to the conventional method16 17 in predicting cardiac mortality and admission with heart failure in patients with isolated diastolic dysfunction or heart failure with preserved LVEF 9…”

“…Previous studies, which evaluated the prognostic value of the MPI either obtained by the conventional method as proposed by Tei and colleagues16 17 or by using the regional TDI velocity curves,18 19 were all performed in selected populations, for example, patients after acute myocardial infarction,23 elderly men,24 patients with cardiac amyloidosis,25 with idiopathic-dilated cardiomyopathy,26 with isolated diastolic dysfunction9 and in patients with systolic heart failure 27. In a population-based study of American Indians,28 the authors found that the MPI obtained by the conventional method16 17 did not predict future cardiovascular events.…”

“…The MPI increases even in patients with severe diastolic dysfunction with a restrictive filling pattern, which is seen as a short IVRT time 8. This is attributable to the increase in IVCT or decrease in ET, illustrating the subtle impaired systolic function identified by novel echocardiographic parameters that is found in patients with severe diastolic dysfunction, even though they display a preserved LVEF 9. Therefore, cardiac time intervals, especially combined indexes containing information on both systolic and diastolic performance (IVRT/ET and MPI), may be useful to identify subtle impairments in cardiac function (both systolic and diastolic) in the general population, which are unnoticed by conventional echocardiography 10 11…”

Prognostic Value of Cardiac Time Intervals by Tissue Doppler Imaging M-Mode in Patients With Acute ST-Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

“…The MPI obtained by the conventional method can provide prognostic information in patients with various cardiac conditions, [17][18][19][20] including AMI. [21][22][23][24][25] Our study is the first to evaluate the prognostic value of the MPI assessed by TDI M-mode through the mitral leaflet in an STEMI population treated by pPCI.…”

Correlation Between Body Mass Index and Echocardiographic Findings in Overweight Patients Compared to Normal-Weight Patients

“…This can result in dysfunction of this cavity and symptoms of heart failure. Left chest X-ray (6). Diagnosis by echocardiography is based on direct observation of the heart and measurement of the parameters necessary for calculating the left ventricular mass and the index of left ventricular function (7).…”