Tei index as a method of evaluating left ventricular diastolic dysfunction in acute myocardial infarction

Abstract

Introduction: The Doppler index of overall left ventricular (LV) myocardial performance--the Tei index--has been shown to be a reliable indicator of all changes in LV systolic dysfunction, retaining an inverse relationship with the ejection fraction. The aim of this study was to examine the corresponding behaviour in relation to LV diastolic dysfunction in patients with acute myocardial infarction (AMI), a relationship that has not been studied previously.

Methods: The study included 105 patients (77 men) with first AMI who were classified into four groups according to the severity of LV diastolic dysfunction: a) 25 patients with normal diastolic function (NDF), b) 36 with decreased peak filling rate pattern (DFR), c) 33 with impaired relaxation (IR) and d) 11 with pseudonormal or restrictive physiology (PN/RP). A complete echocardiographic study, including all conventional systolic and diastolic echo/Doppler parameters as well as measurement of the Tei index, was performed on the eighth post-infarction day (mean 8.07 +/- 0.96 days) in all patients.

Results: In the patients with IR (0.77 +/- 0.05) the index was significantly greater than in those of the NDF (0.55 +/- 0.03, p<0.01) or DFR (0.65 +/- 0.02, p<0.01) groups. The index in the DFR group was greater than in the NDF group, though not significantly so. In contrast, the index in the PN/RP patients (0.59 +/- 0.05) was significantly lower than in the patients with IR (p<0.01), whereas it did not differ from that of the patients in the NDF or DFR groups ("pseudonormalisation" of the index).

Conclusions: The Tei index detects with reliability milder types of diastolic dysfunction. However, because of its "pseudonormalisation" in patients with PN/RP, the Tei index cannot be considered a reliable indicator of more severe patterns of LV diastolic dysfunction in AMI patients.