Value of a Doppler-Derived Index Combining Systolic and Diastolic Time Intervals in Predicting Outcome in Primary Pulmonary Hypertension

Yeo, Tiong Cheng; Dujardin, Karl; Tei, Chuwa; Mahoney, Douglas W.; McGoon, Michael D.; Seward, James B.

doi:10.1016/s0002-9149(98)00140-4

Cited by 494 publications

(278 citation statements)

References 23 publications

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“…The Tei index is a powerful tool with significant prognosis for RV dysfunction in primary PHT (27,34). It is difficult to visualize both tricuspid inflow and pulmonary outflow spectra on the same Doppler window.…”

Section: Discussionmentioning

confidence: 99%

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Boissière¹,

Gautier²,

Machet³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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-We aimed to assess the accuracy of Doppler tissue imaging (DTI) in detecting right ventricle (RV) dysfunction and electromechanical coupling alteration following pulmonary hypertension (PHT) in rat. PHT was induced by chronic hypoxia exposure (hypoxic PHT) or monocrotaline treatment (monocrotaline PHT). In both PHT models, we observed transparietal RV pressure increase and remodeling, including hypertrophy and dilation. Conventional echocardiography provided evidence for pulmonary outflow impairment with midsystolic notch and acceleration time decrease in PHT groups (21.7 Ϯ 1.6 and 13.2 Ϯ 2.9 ms in hypoxic and monocrotaline PHT groups vs. 28.1 Ϯ 1.0 ms in control). RV shortening fraction was decreased in the monocrotaline PHT group compared with the hypoxic PHT and control groups. Combining conventional Doppler and DTI was more helpful to detect RV diastolic dysfunction in the monocrotaline PHT group (E/Ea ratio ϭ 17.0 Ϯ 1.4) compared with the hypoxic PHT and control groups (11.5 Ϯ 0.7 and 10.2 Ϯ 0.4, respectively). Tei index measured using DTI highlighted global RV dysfunction in the monocrotaline PHT group (1.36 Ϯ 0.24 vs. 0.92 Ϯ 0.05 and 0.86 Ϯ 0.05 in the hypoxic PHT and control groups, respectively). Q-S m time measured from the onset of Q wave to the onset of DTI S m wave was increased in both PHT groups. PHT-induced electromechanical coupling alteration was confirmed by in vitro activation-contraction delay measurements on isolated RV papillary muscle, and both Q-S m time and activation-contraction delay were correlated with PHT severity. We demonstrated that Q-Sm time measured in DTI was an easily and convenient index to detect early RV electromechanical coupling alteration in both moderate and severe PHT. echocardiography; hypertrophy; right ventricular remodeling CHRONIC ALVEOLAR HYPOXIA, which often occurs in patients suffering from chronic obstructive pulmonary diseases, secondarily induces a sustained increase in pulmonary artery resistance. The subsequent pulmonary artery hypertension (PHT) leads to right ventricle (RV) pressure overload and hypertrophy (22).Conventional transthoracic echocardiography is widely used to detect PHT in humans and animal models (14, 18). The standard parameters are the RV free wall thickening recorded in time-motion (TM) mode, the presence of mild-systolic notch, and the acceleration time decrease in the pulmonary outflow spectrum recorded in pulsed-Doppler mode. Nevertheless, a more extensive assessment of PHT-induced RV dysfunction remains difficult using conventional echocardiography. Indeed, accuracy of RV systolic and diastolic functions assessment is limited by complex anatomy and geometry of the ventricle.The Tei index, which combines both systolic and diastolic parameters, was suggested to determine global myocardial performance (27). It has been used in the assessment of RV dysfunction, especially in PHT (26). In conventional pulsed Doppler, the Tei index derives from both isovolumic contraction and relaxation times (IVCT and IVRT) as well as ejection time of...

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Section: Discussionmentioning

confidence: 99%

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Boissière¹,

Gautier²,

Machet³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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“…7 Doppler index of myocardial function was calculated. 8 Right atrial area was measured. 9 The amount of pericardial effusion, if present, was assessed using a previously described score.…”

Section: Prognostic Evaluationmentioning

confidence: 99%

Detectable Serum Cardiac Troponin T as a Marker of Poor Prognosis Among Patients With Chronic Precapillary Pulmonary Hypertension

et al. 2003

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“…The Tei Index is independent of heart rate, blood pressure, does not rely on geometric assumptions, is highly reproducible 30 and correlates with invasively measured LV dP/dt 31 . The Tei Index has prognostic value in various patient cohorts 32 and an index > 0.77 proved superior to LVEF in predicting death 33 . Other studies have shown its value in prediction of HF in an elderly cohort 34 as well as predicting lack of treatment response in patients with HF 35 .…”

Section: Traditional Measurementsmentioning

confidence: 99%

Echocardiographic evaluation of systolic heart failure

Thomas

2009

Australas J Ultrason Med

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Echocardiography is the most commonly used modality for evaluating left ventricular size and function in the context of systolic heart failure. Traditional techniques, though extensively used, have their limitations and more recently several newer technologies have emerged that are more reproducible, provide prognostic information, guide therapies and have an important role in monitoring progress. This review will evaluate the traditional and more novel techniques used and briefly provide an overview of the role of echocardiography in guiding and monitoring therapies in patients with systolic heart failure.

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Value of a Doppler-Derived Index Combining Systolic and Diastolic Time Intervals in Predicting Outcome in Primary Pulmonary Hypertension

Cited by 494 publications

References 23 publications

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Detectable Serum Cardiac Troponin T as a Marker of Poor Prognosis Among Patients With Chronic Precapillary Pulmonary Hypertension

Echocardiographic evaluation of systolic heart failure

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