CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 1, February 2012
40
AFRICA
The clinical value of the Tei index among Nigerians
with hypertensive heart failure: correlation with other
conventional indices
AA AKINTUNDE
Abstract
Background:
Various conventional methods are used for
functional evaluation and risk stratification in heart failure.
A combined index of global myocardial performance called
the Tei index has been described. The aim of this study
was to evaluate the correlation of the Tei index with other
conventional indices of systolic and diastolic function among
Nigerians with hypertensive heart failure.
Methods:
Fifty-five subjects with hypertensive heart failure
and 30 controls were examined, a clinical history was taken,
and echocardiography was performed on them. The subjects
were categorised into four groups based on their ejection
fraction (normal ejection fraction, mild, moderate and severe
heart failure). The Tei index was calculated as the sum of the
isovolumic relaxation and contraction time, divided by the
ejection time. Statistical analysis was done using SPSS 16.0.
Results:
The Tei index was significantly higher among
subjects with hypertensive heart failure compared with the
controls (0.91
±
0.33 vs 0.28
±
0.16,
p
<
0.005). The Tei index
also increased with the severity of the heart failure and was
inversely correlated with ejection fraction (
r
=
–
0.697,
p
<
0.001) and fractional shortening (
r
=
–
0.580,
p
=
0.001). It was
directly correlated with mitral E/A ratio (
r
=
0.246,
p
=
0.030),
left ventricular internal diastolic dimension (
r
=
0.414,
p
=
0.002), left ventricular internal systolic dimension (
r
=
0.596,
p
<
0.001) and deceleration time (
r
=
0.219,
p
=
0.032).
Conclusion:
The Tei index correlated significantly with other
conventional indices of systolic and diastolic function among
Nigerians with hypertensive heart failure. It can be used as a
risk-stratification index similar to other traditional indices of
systolic and diastolic function.
Keywords:
hypertensive heart failure, correlation, Tei index,
systolic dysfunction, diastolic dysfuntion, Africans, Doppler
echocardiography
Submitted 24/12/09, accepted 6/6/11
Cardiovasc J Afr
2012;
23
: 40–43
DOI: 10.5830/CVJA-2011-032
Heart failure worldwide is increasingly becoming a serious
public health concern as the population continually ages and
the risk factors for heart failure are increasingly prevalent.
1
Hypertension remains a common cause of heart failure in
Africa.
2
Congestive heart failure includes systolic and/or dias-
tolic dysfunction; systolic dysfunction involves abnormalities
with contractility, diastolic dysfunction is associated with relaxa-
tion abnormalities.
Heart failure is associated with significant morbidity and
mortality.
1
Long-term prognoses are comparable with malig-
nancies.
2
It is a progressive disease associated with significant
economic losses.
3
While systolic dysfunction predominates in
some patients, others have diastolic dysfunction with normal
ejection fraction. It has been suggested that heart failure subjects
often have both systolic and diastolic function together, although
the nomenclature is mostly based on the predominant type of
dysfunction. An important modality in its management is risk
stratification at diagnosis and during therapy.
Currently, echocardiography is the single most useful non-
invasive investigation used in the risk stratification of subjects
with heart failure.
4
Echocardiographic parameters used in assess-
ing systolic function include ejection fraction, cardiac output and
fractional shortening, while diastolic function can be evaluated
by transmitral Doppler inflow or pulmonary venous flow stud-
ies.
5,6
These have been closely related to prognosis.
7
Each of these
parameters is an independent but limited predictor of morbidity in
subjects with heart failure. Therefore, a combined index of systol-
ic and diastolic dysfunction may be a better prognostic index.
The Tei index was introduced in 1995.
8
It is a combined esti-
mate of the systolic and diastolic function obtained from Doppler
echocardiography. Isolated assessment of systolic or diastolic
dysfunction may not reflect the combined abnormality in such
patients, and a combined myocardial performance index may be
more effective in analysing the overall function/dysfunction in
such patients.
The Tei index has been shown to correlate with other indices
of systolic and diastolic function in subjects with heart fail-
ure, dilated cardiomyopathy, amyloidosis and congenital heart
disease in other populations.
9-
12
However, reports among blacks
Africans are scarce. This study was set to evaluate the clinical
value of the Tei index of overall myocardial performance among
black African subjects with a clinical diagnosis of heart failure.
Methods
Fifty-five consecutive subjects with a clinical diagnosis of hyper-
tensive heart failure were included in this study. Thirty age- and
gender-matched controls with a similar mean age were recruited
as controls. They were patients’ relatives and hospital staff who
gave their consent to participate in the study.
Congestive heart failure was clinically diagnosed by the
presence of related symptoms of left and/or right heart failure
according to the Framingham criteria. Hypertensive heart failure
was diagnosed by ascertaining a previous diagnosis and treat-
Division of Cardiology, LAUTECH Teaching Hospital,
Osogbo, Osun State, Nigeria
Cardiology Clinic, University Hospital of Tübingen,
Department of Internal Medicine III, Eberhard Karls
University, Tubingen,Germany
AA AKINTUNDE, MB ChB, FWACP,
