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Open access

Sadie Bennett, Arzu Cubukcu, Chun Wai Wong, Timothy Griffiths, Cheryl Oxley, Diane Barker, Simon Duckett, Duwarakan Satchithananda, Ashish Patwala, Grant Heatlie, and Chun Shing Kwok

Background: Anthracycline agents are known to be effective treatments for solid tumors and hematological malignancies. Although these agents improve survival, their use is associated with cardiotoxic effects, which most commonly manifests as left ventricular systolic dysfunction (LVSD). As such guidelines recommend the periodic assessment of left ventricular ejection fraction (LVEF). However, as diastolic dysfunction likely proceeds systolic impairment in this setting, the role of Tei index may offer additional benefit in detecting subclinical LVSD.

Methods: We conducted a systematic review to investigate the evidence for the use of Tei index in assessing for subclinical cardiotoxicity in patients receiving anticancer agents. A search of Medline and EMBASE was performed and relevant studies were reviewed and narratively synthesized.

Results: A total of 13 studies were included with a total of 800 patients (mean age range 46-62 years, percentage of male participants ranged from 0%-86.9%). An increase in Tei index was observed in 11 studies, which suggesting a decline in cardiac function following chemotherapy. Out of these, 6 studies indicated that the Tei index is a useful parameter in predicting cardiotoxic LVSD. Furthermore, 5 studies indicated Tei index to be superior to LVEF in detecting subclinical cardiotoxicity.

Conclusions: While there are some studies that suggest that Tei index may be a useful indicator in assessing for subclinical anthracycline related cardiotoxicity, the findings are inconsistent so more studies are needed before the evaluation of Tei index should be performed routinely in patients receiving chemotherapy.

Open access

Sadie Bennett, Chun Wai Wong, Timothy Griffiths, Martin Stout, Jamal Nasir Khan, Simon Duckett, Grant Heatlie, and Chun Shing Kwok

Background

Echocardiographic evaluation of left ventricular ejection fraction (LVEF) is used in the risk stratification of patients with an acute myocardial infarction (AMI). However, the prognostic value of the Tei index, an alternative measure of global cardiac function, in AMI patients is not well established.

Methods

We conducted a systematic review, using MEDLINE and EMBASE, to evaluate the prognostic value of the Tei index in predicting adverse outcomes in patients presenting with AMI. The data was collected and narratively synthesised.

Results

A total of 16 studies were including in this review with 2886 participants (mean age was 60 years from 14 studies, the proportion of male patients 69.8% from 14 studies). Patient follow-up duration ranged from during the AMI hospitalisation stay to 57.8 months. Tei index showed a significant association with heart failure episodes, reinfarction, death and left ventricular thrombus formation in 14 out of the 16 studies. However, in one of these studies, Tei index was only significantly predictive of cardiac events in patients where LVEF was <40%. In two further studies, Tei index was not associated with predicting adverse outcomes once LVEF, left ventricular end-systolic volume index and left ventricular early filling time was taken into consideration. In the two remaining studies, there was no prognostic value of Tei index in relation to patient outcomes.

Conclusions

Tei index may be an important prognostic marker in AMI patients, however, more studies are needed to better understand when it should be used routinely within clinical practice.