CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 3, May/June 2011
Cardiovascular Topics
124
AFRICA
Relationship between Tei index of myocardial
performance and left ventricular geometry in Nigerians
with systemic hypertension
ADESEYE A AKINTUNDE, PATIENCE O AKINWUSI, GEORGE O OPADIJO
Abstract
Introduction:
Left ventricular geometry is associated with
cardiovascular events and prognosis.TheTei index of myocar-
dial performance is a combined index of systolic and diastolic
dysfunction and has been shown to be a predictor of cardio-
vascular outcome in heart diseases. The relationship between
the Tei index and left ventricular geometry has not been well
studied. This study examined the association between the
Tei index and left ventricular geometry among hypertensive
Nigerian subjects.
Methods:
We performed echocardiography on 164 hyper-
tensives and 64 control subjects. They were grouped into
four geometric patterns based on left ventricular mass and
relative wall thickness. The Tei index was obtained from the
summation of the isovolumic relaxation time and the isovolu-
mic contraction time, divided by the ejection time. Statistical
analysis was done using SPSS 16.0.
Results:
Among the hypertensive subjects, 68 (41.4%) had
concentric hypertrophy, 43 (26.2%) had concentric remodel-
ling, 24 (14.6%) had eccentric hypertrophy, and 29 (17.7%)
had normal geometry. The Tei index was significantly higher
among the hypertensives with concentric hypertrophy (CH),
concentric remodelling (CR) and eccentric hypertrophy
(EH) compared to the hypertensives with normal geometry
(0.83
±
1.0, 0.71
±
0.2, 0.80
±
0.2 vs 0.61
±
0.2, respectively).
The Tei index was higher among hypertensives with CH and
EH than those with CR. Stepwise regression analysis showed
that the Tei index was related to ejection fraction, fractional
shortening and mitral E/A ratio.
Conclusion:
Among Nigerian hypertensives, LV systolic and
diastolic functions (using the Tei index) were impaired in
all subgroups of hypertensive patients according to their
left ventricle geometry compared to the control group. This
impairment was more advanced in patients with concentric
and eccentric hypertrophy.
Keywords:
Tei index, hypertension, left ventricle geometry,
echocardiography
Submitted 18/5/10, accepted 30/6/10
Cardiovasc J Afr
2011;
22
: 124–127
DOI: CVJ-21.038
Hypertension remains the commonest cardiovascular risk factor
in Nigeria.
1
Left ventricular adaptations to hypertension include
the development of left ventricular hypertrophy and several
geometric alterations.
2,3
These geometric variations are associ-
ated with significant morbidity and mortality, with various stud-
ies suggesting that subjects with concentric hypertrophy have a
higher incidence of cardiovascular events, and those with eccen-
tric hypertrophy are much more at risk of progressing to heart
failure than those with other left ventricular geometric patterns.
4-6
Other studies suggest that major cardiovascular events are simi-
lar between the four groups of geometric patterns.
7,8
However,
left ventricular function has been shown to vary between the
different left ventricular geometric patterns.
8-10
Hypertension can lead to both systolic and diastolic abnor-
malities. There are several conventional indices for evaluating
systolic function, such as ejection fraction, cardiac output,
cardiac index and fractional shortening, while diastolic index can
be assessed among others by transmitral Doppler wave pattern,
isovolumic relaxation time, tissue Doppler and deceleration time.
These indices are specific for systolic or diastolic function and
each is associated with significant limitations with regard to their
interpretation/relevance to clinical status and haemodynamic
state.
The myocardial performance index, otherwise called the Tei
index, is a combined index of systolic and diastolic dysfunction
and has been shown to correlate significantly with other conven-
tional indices.
11,12
Whether there is any relationship between the
Tei index and left ventricular geometry among blacks is not
well known. Hence this study aimed to describe the relationship
between left ventricular geometry and the myocardial perfor-
mance index among hypertensive Nigerian subjects.
Methods
Patients and controls were consecutively recruited from the
echocardiographic laboratory of our hospital. This study was
cross-sectional and comprised 164 hypertensive subjects seen
at the cardiology clinic of our hospital. They had had complete
echocardiography done on them, including two-dimensional,
Division of Cardiology, Ladoke Akintola University of
Technology Teaching Hospital, Osogbo, Nigeria
ADESEYE A AKINTUNDE, MB ChB, FWACP
PATIENCE O AKINWUSI, MB ChB, FWACP
GEORGE O OPADIJO, MB BS, FWACP
Cardiology Clinic, Eberhards Karls University, Tubingen,
Germany
ADESEYE A AKINTUNDE, MB ChB, FWACP, adeseyeakintunde@
hotmail.com
