CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 1, February 2012
AFRICA
43
Systolic time intervals have been shown to correlate with systolic
left ventricular performance.
21,22
Similarly, diastolic time inter-
vals have been shown to correlate with left ventricular diastolic
performance in several patient populations.
23,24
The Tei index is non-invasive and easily obtainable. It has
also been shown to have prognostic significance in subjects with
heart failure.
8,9,12,15,25
Ejection fraction is the most commonly used
method to estimate left ventricular function and was well corre-
lated with the Tei index in our study. The Tei index was signifi-
cantly higher among subjects with higher systolic dysfunction.
Fractional shortening, deceleration time and mitral E/A ratio
also correlated well with the Tei index. Our study is in agreement
with similar studies that had shown that the Tei index can be a
useful prognostic index and an accurate estimate of overall left
ventricular function in a wide variety of subjects.
8,9,12,26,27
Several authors have argued that some degree of systolic and
diastolic dysfunction coexist in almost all patient with heart fail-
ure.
28,29
A measurement such as the Tei index therefore seems to
be more appropriate for estimating overall ventricular function.
This has also been reported by other authors.
9,15
The Tei index
provides useful information and clinical value in patients with
heart failure of various origins, including hypertensive heart
disease, rheumatic heart disease, dilated cardiomyopathy and
alcoholic heart muscle disease. The prognostic usefulness of the
Tei index as a combined index of overall heart function in black
African subjects should be further studied.
As promising as the Tei index is, it is not yet clear whether it
has any role in the aetiological classification of heart failure or in
differentiating systolic from diastolic heart failure. These could
be assessed by further prospective studies.
Conclusion
The Tei index correlated well with conventional indices of
systolic and diastolic dysfunction in subjects with hypertensive
heart failure. It may be an additional tool for risk stratification,
treatment evaluation and prognosis in black Africans.
References
1.
Commerford P, Mayosi B. An appropriate research agenda for heart
disease in Africa.
Lancet
2006;
367
: 1884–1886.
2.
Stewart S. Prognosis of patients with heart failure compared with
common types of cancer.
Heart Fail Monit
2003;
3
(3): 87–94.
3.
Szucs TD, Sokolovic E. Economic significance of heart failure.
Herz
2000;
25
(5): 538–546.
4.
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R,
Feigenbaum H,
et al
. Recommendations for quantification of the left
ventricle by two-dimensional echocardiography.
J Am Soc Echo
1989;
2
: 358–367.
5.
LittleWC, Warner JG, Rankin KM, Kitzman DW, Cheng CP. Evaluation
of left ventricular diastolic function from the pattern of left ventricular
filling
. Clin Cardiol
1998;
21
(1): 5–9.
6.
Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Assessment of diastolic
function of the heart: background and current applications of Doppler
echocardiography. Part II. Clinical studies.
Mayo Clin Proc
1989;
64
:
181–204.
7.
Vitarelli A, Tiukinhoy S, Di Luzio S, Zampino M, Gheorghiade M. The
role of echocardiography in the diagnosis and management of heart
failure.
Heart Fail Rev
2003;
8
: 181–189.
8.
Tei C. New non-invasive index for combined systolic and diastolic
ventricular function.
J Cardiol
1995;
26
: 396–404.
9.
Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik
AJ, Seward JB. New index of combined systolic and diastolic myocar-
dial performance: a simple and reproducible measure of cardiac func-
tion: a study in normals and dilated cardiomyopathy.
J Cardiol
1995;
26
: 357–366.
10. McMahon CJ, Nagueh SF, Eapen RS, Dreyer WJ, Finkelshtyn I, Cao X,
et al.
Echocardiographic predictors of adverse clinical events in chil-
dren with dilated cardiomyopathy: a prospective clinical study.
Heart
2004;
90
(8): 908–915.
11. Tei C, Dujardin KS, Hodge DO, Kyle RA, Tajik AJ, Seward BJ. Doppler
index combining systolic and diastolic myocardial performance: clini-
cal value in cardiac amyloidosis
. J Am Coll Cardiol
1996;
28
: 658–664.
12. Falkensammer CB, Paul J, Huhta JC. Fetal congestive heart failure:
correlation of Tei index and cardiovascular score.
J Perinat Med
2001;
29
(5): 390–398.
13. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R,
Feigenbaum H,
et al.
Recommendations for quantitation of the left
ventricle by two-dimensional echocardiography: American Society of
Echocardiography committee on standards, subcommittee on quanti-
tation of two-dimensional echocardiograms.
J Am Soc Echocardiogr
1989;
2
: 358–367.
14. Wilson DJ, North N, Wilson RA. Comparism of left ventricular ejection
fraction calculation methods.
Echocardiography
1998;
15
(8): 709–712.
15. Sutton J, Wiegers S. The Tei index – a role in the diagnosis of heart
failure?
Eur Heart J
2000;
21
: 1822–1824.
16. Ntusi NB, Mayosi BM. Epidemiology of heart failure in sub-Saharan
Africa. E
xpert Rev Cardiovasc Ther
2009;
7
(2): 169–180.
17. Amoah AG, Kallen C. Aetiology of heart failure as seen from a national
cardiac referral centre in Africa.
Cardiology
2009;
93
(1-2): 11–18.
18. Jessup M, AbrahamWT, Casey DE. 2009 Focused update: ACCF/AHA
guideline for the diagnosis and management of heart failure in adults.
J
Amer Coll Cardiol
2009;
53
(15): 1343–1382.
19. Thomas JD, Weyman AE. Echo Doppler evaluation of left ventricu-
lar diastolic function: physics and physiology.
Circulation
1991;
84
:
977–990.
20. Yeo TC, Dujardin KS, Tei C, Mahoney DW, McGoon MD, Seward JB.
Value of a Doppler-derived index combining systolic and diastolic time
intervals in predicting outcome in primary pulmonary hypertension.
Am
J Cardiol
1998;
81
(9): 1157–1161.
21. Gondi S, Dokainish H. Right ventricular tissue Doppler and strain
imaging: ready for clinical use?
Echocardiography
2007;
24
(5):
522–532.
22. Nishimura RA, Tajik JA. Evaluation of diastolic filling of left ventri-
cle in health and disease: Doppler echocardiography is the clinician’s
Rosetta stone.
J Am Coll Cardiol
1997;
30
: 8–18.
23. Ling LH, Tei C, McCully RB, Bailey KR, Seward JB, Pellikka PA.
Analysis of systolic and diastolic time intervals during dobutamine-
atropine stress echocardiography –diagnostic potential oft he Doppler
myocardial performance index.
J Am Soc Echocardiogr
2001;
14
(10):
978–986.
24. Tenenbaum A, Motro M, Hod H, Kaplinky E, Vered Z. Shortened
Doppler-derived mitral A wave deceleration time: an important predic-
tor of elevated left ventricular filling pressure.
J Am Coll Cardiol
1996;
27
: 700–705.
25. Acil T, Wichter T, Stypmann J, Janssen F, Paul M, Grude M,
et al
.
Prognostic value of tissue Doppler imaging in patients with chronic
congestive heart failure.
Int J Cardiol
2005;
103
(2): 175–181.
26. Dujardin KS, Tei C, Yeo TG, Hodge DO, Rossi A, Seward JB.
Prognostic value of a Doppler index combining systolic and diastolic
performance in idiopathic-dilated cardiomyopathy.
Am J Cardiol
1998;
82
(9): 1071–1076.
27. Bruch C, Schmermund A, Marin D, Katz M, Bartel T, Schaar J,
et al.
Tei index in patients with mild to moderate congestive heart failure.
Eur
Heart J
2000;
21
: 1888–1895.
28. Mogelvang R, Goetze JP, Pedersen SA , Olsen NT, Marott JL, Schnohr
P,
et al
. Preclinical systolic and diastolic dysfunction assessed by tissue
Doppler imaging is associated with elevated plasma pro-B-type natriu-
retic peptide concentrations.
J Card Fail
2009;
15
(6): 489–495.
29. Sanderson JE. Heart failure with a normal ejection fraction
. Heart
2007;
93
(2): 155–158.
