Cardiovascular Journal of Africa: Vol 28 No 1 (January/February 2016)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017

AFRICA

Cardiovascular Topics

Relationship between myocardial performance index

and severity of coronary artery disease in patients with

non-ST-segment elevation acute coronary syndrome

Okay Abaci, Cuneyt Kocas, Veysel Oktay, Sukru Arslan, Yusuf Turkmen, Cem Bostan, Ugur Coskun,

Ahmet Yildiz, Murat Ersanlı

Abstract

Objectives:

We aimed to investigate the relationship between

myocardial performance index (MPI) and severity of coro-

nary artery disease, as assessed by the Gensini score (GS), in

patients with non-ST-segment elevation myocardial infarction

(NSTEMI).

Methods:

Ninety patients with an initial diagnosis of

NSTEMI were enrolled in our study. They were divided into

tertiles according to the GS: low GS

19; mid GS

19 and

≤

96; and high GS

96.

Results:

The low-, mid- and high-GS groups included 24, 38

and 28 patients, respectively. Clinical features such as gender

distribution; body mass index (BMI); prevalence of diabetes

mellitus, hypertension and hyperlipidaemia; and smoking status

were similar in the three groups. MPI and isovolumic relaxation

time were significantly higher in the high-GS group than in the

low- and mid-GS groups (

0.001 and

0.005, respectively).

Furthermore, the high-GS group had a significantly lower ejec-

tion fraction and ejection time (

0.01 and

0.001, respec-

tively). MPI was positively correlated with the GS (

0.47,

0.001), and multivariate regression analysis showed that MPI

was an independent predictor of the GS (

β =

0.358,

0.001).

Conclusions:

Patients with NSTEMI who fall within the

high-risk group may be identified by means of a simple MPI

measurement.

Keywords:

Tei index, Gensini score, acute coronary syndrome

Submitted 22/10/13, accepted 3/4/16

Cardiovasc J Afr

2017;

: 4–7

www.cvja.co.za

DOI: 10.5830/CVJA-2016-041

Non-ST-segment elevation myocardial infarction (NSTEMI) is

one of the leading causes of morbidity and mortality, and accounts

for high healthcare costs worldwide. The Gensini scoring system,

based on angiographic findings, is a valuable method for estimating

the severity of coronary artery disease.

1,2

The severity of coronary

artery lesions, as assessed by the Gensini score (GS), is associated

with long-term mortality and major adverse cardiac event rates.

Doppler-derived myocardial performance index (MPI), also

known as the Tei index, is a new diagnostic method and an

alternative to ejection fraction (EF) measurements. This index

reflects combined systolic and diastolic function and can be

defined as the sum of the isovolumic contraction time and

isovolumic relaxation time, divided by the ejection time, with a

reported normal mean

standard deviation (SD) value for the

left ventricle of 0.39

0.05.

Adverse outcomes are infrequently

seen among patients with preserved global ventricular function.

MPI has been identified as a powerful independent predictor

of death from all causes in patients with a recent acute myocardial

infarction (AMI). In this study, we aimed to determine the

association between the severity of coronary atherosclerosis as

assessed by the GS and MPI in patients with NSTEMI.

Methods

Thestudywasaprospective,single-centreanalysisof 90consecutive

patients with an initial diagnosis of NSTEMI. Patients who had

valvular heart disease, cardiomyopathy, congestive heart failure,

previous cardiac surgery, history of percutaneous coronary

intervention, chronic kidney disease, hepatic dysfunction, acute

respiratory illness, acute infection, chronic inflammatory disease,

or complex congenital heart disease were excluded from the study.

Patients who were diagnosed with peripheral arterial disease or

a coronary artery disease (CAD) equivalent were also excluded.

Data on demographics, established cardiovascular risk

factors and medical history were obtained for each patient.

Written informed consent was obtained from all subjects, and

the investigation conformed to the principles outlined in the

Decleration of Helsinki. The local ethics committee approved

the study protocol.

Echocardiographic evaluation

All patients underwent echocardiographic evaluation using

a standard protocol on commercially available systems (GE

Department of Cardiology, Cardiology Institute of Istanbul

University, Istanbul, Turkey

Okay Abaci, MD,

drokayabaci@hotmail.com

Cuneyt Kocas, MD

Veysel Oktay, MD

Sukru Arslan, MD

Yusuf Turkmen, MD

Cem Bostan, MD

Ugur Coskun, MD

Ahmet Yildiz, MD

Murat Ersanlı, MD