Original article
Left Ventricle Myocardial Performance Index Derived Either By Conventional Method or Mitral Annulus Tissue-Doppler: A Comparison Study in Healthy Subjects and Subjects with Heart Failure

https://doi.org/10.1016/j.echo.2005.06.006Get rights and content

Objectives

The aims of this study were to investigate the clinical agreement between myocardial performance index (MPI) measured conventionally and by pulsed-wave tissue Doppler (PW-TD) of the mitral annulus, and to test whether PW-TD MPI can accurately differentiate between healthy subjects and patients affected by congestive heart failure (CHF) with mild to moderate reduction of systolic function.

Background

Calculation of MPI using PW-TD may have advantages over conventional left ventricle inflow/outflow tract pulsed-wave Doppler (PWD) method; for example, all of the data needed for PW-TD MPI calculation can be derived from one single cardiac cycle, whereas with PWD at least two different cycles are needed. Thus, heart rate variability does not interfere with PW-TD MPI.

Methods and Results

In group A, we included 70 healthy adults with normal left ventricular ejection fraction and normal diastole, whereas for group B we studied 50 patients with CHF and left ventricular ejection fraction between 35% and 45%. MPI measured with PWD was statistically different (P < .0001) from MPI measured with PW-TD both in group A (0.33 ± 0.09 vs 0.42 ± 0.09) and group B (0.69 ± 0.15 vs 0.79 ± 0.12). Nonetheless, clinical agreement existed between the two methods in the single subject. Receiver operating characteristic curves showed very high accuracy for both methods to discriminate patients with CHF from healthy subjects; the optimal cutoff point was different and specific to each method: 0.50 for the conventional method and 0.60 for the PW-TD method.

Conclusion

We found clinical agreement between MPI measured in the same subject with the conventional PWD method and with PW-TD. Both methods had similarly high diagnostic accuracy for CHF, but this study supports the use of a higher MPI cut-point for best diagnostic accuracy when using the new PW-TD method.

Summary

We performed a study in healthy adults and in patients with congestive heart failure to investigate the clinical agreement between MPI measured conventionally and by PW-TD of the mitral annulus. We found mild agreement between MPI measured by the conventional method and by PW-TD. Both methods had high diagnostic accuracy for CHF. PW-TD method requires a higher MPI cut-point for best diagnostic accuracy.

Section snippets

Study Population

Group A consisted of 70 consecutive healthy adults who were studied on the basis of the following inclusion criteria: age between 20 and 55 years, normal sinus rhythm, normal blood pressure, left ventricular ejection fraction (LVEF) greater than 50% and otherwise normal echocardiogram with normal diastolic transmitral PW-Doppler pattern, normal diastole at PW-TD, and absence of any known cardiac or noncardiac disease. Exclusion criteria were inadequate visualization and presence of bundle

Results

Patient demographics, LVEF, Doppler, tissue Doppler parameters, and MPI in the study groups are reported in Table 1. Figure 3 graphically shows MPI values obtained using both methods for both study groups. MPI measured by PW-TD was significantly higher (P < .0001) than MPI measured conventionally with PWD MPI both in group A (0.42 ± 0.09 vs 0.33 ± 0.09) and group B (0.79 ± 0.12 vs 0.69 ± 0.15). These results were driven by longer “a1” intervals compared with “a” intervals in the same group;

Discussion

Both PWD and PW-TD MPI have very high sensitivity and specificity to differentiate between healthy subjects and patients affected by CHF with mild to moderate reduction of systolic function.

Mild agreement was found between the conventional PWD and the new PW-TD method for MPI calculation when used in a single subject, but optimal cutoff values to diagnose CHF were different, 0.50 and 0.60, respectively.

Conclusion

This study supports the use of a different, higher MPI cut-point for best diagnostic accuracy when using the new PW-TD method compared with the conventional one.

The present study suggests that PW-TD MPI is an excellent alternative to conventional MPI; PW-TD MPI may be particularly useful when PWD intervals are technically difficult to measure or a high beat-to-beat heart rate variability may impair MPI calculation with conventional PWD.

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