The prognostic value of Tei index in acute myocardial infarction: a systematic review

in Echo Research and Practice
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  • 1 Royal Stoke University Hospital, Stoke-on-Trent, UK
  • 2 Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK
  • 3 Manchester University NHS Foundation Trust, Manchester, UK
  • 4 University Hospitals of Coventry & Warwickshire, Coventry, UK

Correspondence should be addressed to S Bennett: sadie.bennett@uhnm.nhs.uk

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.

Abstract

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.

Introduction

First described in 1995 (1), the Tei index, also known as a myocardial performance index, is a ratio of systolic and diastolic time intervals which can be easily obtained from Doppler echocardiography. This timing ratio, characterised by the sum of the isovolumetric contraction time and isovolumetric relaxation time divided by the overall ejection time, has been well validated in the assessment of overall global myocardial performance in both adult and paediatric populations (1, 2). Although Tei index is not a frequently used measurement in assessing cardiac function in current clinical practice, there is evidence to suggest that the Tei index is a simple, reliable and reproducible measurement in patients with congestive heart failure, congenital heart disease and cardiac rejection post-transplantation (3). Tei index has also been shown to have prognostic value in patients with cardiac amyloidosis and dilated cardiomyopathy (4, 5).

An acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide (6) with known complications including congestive heart failure, functional and structural myocardial abnormalities, reinfarction and death. In the setting of an AMI, echocardiography is a well-established risk stratification tool (7, 8). Consequently, echocardiographic assessment in the early post-AMI stage forms part of national and international guidelines (9, 10). An important echocardiographic measurement for post-AMI patients is the assessment of left ventricular systolic function via left ventricular ejection fraction (LVEF) which is well associated with short-term and long-term outcomes (11, 12, 13). However, it is well recognised that systolic and diastolic function are tightly connected at a cellular, myocardial and hemodynamic level (14). As such, Tei index, which considers both contraction and relaxation timing intervals, may provide important prognostic information in patients presenting with AMI which may go unmissed with the isolated evaluation of LVEF. Furthermore, the Tei index is less affected by image quality compared to LVEF and GLS which makes the index an attractive parameter for the assessment of global left ventricular function.

Studies in the literature evaluating the prognostic value Tei index after AMI are inconsistent with studies reporting an association between a greater Tei index and adverse events (15, 16, 17, 18). Whilst other studies either conclude there to be no association (19) or, that Tei index offer no additional benefit over the more routinely used LVEF measurement (20). In view of the importance of understanding the prognostic value of the Tei index in AMI patients and the inconsistencies reported, we conducted a systematic review of the literature to evaluate what is currently known.

Methods

We conducted a systematic review to evaluate the current literature on the prognostic value of Tei index in patients presenting with an AMI. Tei index was defined as per Fig. 1. Study inclusion criteria included: retrospective cohort studies, prospective cohort studies and matched control studies. Excluded criteria consisted of conference abstracts, animal studies, case studies, case series, studies using bare-metal stents used as part of the AMI treatment plan. Studies that analysed the same cohort were also excluded to avoid duplication of results.

Figure 1
Figure 1

Schematic representation of Tei index.

Citation: Echo Research and Practice 7, 4; 10.1530/ERP-20-0017

A search of MEDLINE and EMBASE was performed on OVID using the search terms ‘Tei index’, ‘myocardial performance index’, ‘acute coronary syndrome’, ‘acute myocardial infarction’, ‘STEMI’ in April 2020. The search results were independently reviewed for inclusion by two reviewers (SB and CSK). Full text of potentially relevant studies was downloaded and reviewed for final inclusion. Data extractions were performed by two independent reviewers (SB and CSK). Extracted information included study design, year, country the study was conducted in, number of participants, mean age of participants, percentage of male participants, participant inclusion criteria, echocardiographic findings, prognostic outcomes/clinical outcomes of Tei index. The Newcastle–Ottawa quality assessment scale was used to assess the quality of each included study (21). The Newcastle-Ottawa scale was incorporated into this review as it enables a standardised and comprehensive assessment of nonrandomised studies to be quality assessed against (21). Results from the extractions are presented in tables. The results were narratively synthesised.

Results

Our search results yielded 144 potential inclusions and after detailed screening and review, a total of 16 studies were included in the review (Fig. 2) (6, 14, 15, 16, 17, 18, 19, 20, 22, 23, 24, 25, 26, 27, 28, 29). These studies included 14 cohort studies and 2 matched control studies (Table 1). In total, 15 out of the 16 studies that reported when the studies had been conducted showed that the studies were performed between 1995 and 2015. The studies took place around the world including Denmark, Norway, Egypt, Japan, Israel, Brazil, Poland, Turkey, Sweden and Romania. Overall, there were a total of 2886 participants with individual study participant numbers ranging from 44 to 417. From 14 studies that reported mean age of participants, the average overall age was 60 years. From 14 studies which reported participant sex, the overall mean percentage of male participants was 69.8%. Only 7 of the 16 included studies, included patients with first AMI. Detailed echocardiographic parameters that were reported in each of the included studies are shown in Supplementary Table 1 (see section on supplementary materials given at the end of this article).

Figure 2
Figure 2

Flow diagram of studies inclusion.

Citation: Echo Research and Practice 7, 4; 10.1530/ERP-20-0017

Table 1

Description of studies.

Study ID

Study design; Country; Year

No. of patients

Mean age

Male %

Inclusion criteria

Exclusion criteria

Abuomara 2018Prospective cohort study; Egypt; 2014–2015605470Patients with first acute anterior STEMI treated with primary PCI.Known dilated cardiomyopathy, previous PCI or CABG, non-sinus rhythm.
Biering-Sørensen 2013Prospective cohort study; Denmark; 2006–20083866275Patients with STEMI treated with primary PCI.Poor quality echocardiography images.
Hole 2003Prospective cohort study; Norway; 1995–1997716573Patients in sinus rhythm with AMI without heart failure.Unstable angina requiring PCI, CABG, heart failure, AF, comorbid non-cardiac disease reducing life expectancy <2 years.
Karvounis 2004Matched control study; Greece; unclear685378Patients who survived AMI who received thrombolysis.Previous Q wave myocardial infarction, AF, moderate to severe mitral regurgitation, severe aortic stenosis.
Møller 2001Prospective cohort study; Denmark; unclear12568UnclearPatients with first AMI.Aortic stenosis, implanted pacemaker and dementia.
Møller 2003Prospective cohort study; Denmark; 1998–1999799Median 6968Patients with definite AMI.Incomplete Doppler echocardiography.
Rahman 2009Prospective cohort study; Pakistan; 2006–2007202Unclear78Patients with AMI.Significant mitral regurgitation or aortic stenosis, inadequate echo images, congenital heart disease.
Sasao 2004Matched control study; Japan; 2000–2001536372Patients with first AMI treated with primary PCI.Slow flow after post-PCI, presence of mechanical complications, previous myocardial infarction, AF, CABG, recent PCI, inadequate recording of echocardiography.
Schwammenthal 2003Cohort study; Israel; unclear4176278Patients with AMI.Patients who did not have echo evaluation.
Souza 2011Prospective cohort study; Brazil; unclear955867Patients with first STEMI.Previous AMI, early reinfarction, early reinfarction, in-hospital death, previous CABG or PCI, left bundle branch block, non-sinus rhythm, valvular heart disease, dilated cardiomyopathy, poor echocardiography images.
Szymanski 2002Prospective cohort study; Poland; unclear905871Patients who were hospital survivors of AMI.AF, sinus tachycardia, significant mitral/aortic stenosis/regurgitation, inadequate echocardiography studies.
Uzunhasan 2006Prospective cohort study; Turkey; 2001–2002775375Patients with transmural first myocardial infarction.AF, permanent pacemaker, dementia, aortic stenosis, inappropriate Doppler recordings, chronic obstructive pulmonary disease.
Westholm 2013Prospective cohort study; Sweden; 2006–20082276776Patients admitted with an AMI.None.
Yilman 2004Prospective cohort study; Turkey; unclear925888Patients with first anterior AMI.Rhythm and conduction abnormalities, prior AMI, cardiomyopathy, valvular heart disease, lung disease, pulmonary hypertension, patients who underwent PCI, poor echocardiography images
Yuasa 2005Cohort study; Japan; unclear806478Patients with first anteroseptal AMI.Multiple infarctions, congenital, pericardial and organic valvular heart disease.
Zamfir 2016Prospective cohort study; Romania; 2015–2016446370Patients with acute STEMI treated with primary PCI.Previous history of cardiac or pulmonary disease.

AF, atrial fibrillation; AMI, acute myocardial infarction; CABG, coronary artery bypass graft; PCI, percutaneous coronary intervention; STEMI, ST elevation myocardial infarction.

All studies used transthoracic echocardiography to assess Tei index, 3 of which used tissue Doppler image with the remaining studies using trans-mitral and left ventricular outflow time intervals obtained from either continuous or pulsed wave Doppler studies. Of the 16 studies, 10 included all coronary territory AMI patients, two studies included only anterior AMI patients, one included only anteroseptal AMI patients, the three studies did not comment on the coronary territory. Twelve studies indicated that the Tei index measurements were undertaken during the same hospitalisation of the AMI. However, the timing of the Tei index measurement in relation to the AMI event varied within 1 h of the angioplasty procedure to within 7 days of AMI. Table 2 shows the quality assessment which was undertaken on all of the included studies in this review. The Newcastle-Ottawa Quality assessment tool indicated that 3 out of 16 studies were of fair quality while the remaining studies were of good quality. Of the 16 included studies, 14 studies indicated that a high Tei index value showed a significant association with heart failure episodes, reinfarction, death and left ventricular thrombus (Table 3). These are discussed separately below.

Table 2

Study quality assessment using Newcastle Ottawa Scale.

Study IDTiming of Tei index measurementsNewcastle-Ottawa Quality assessment
Selection domainaComparability domainbOutcome domaincOverall
Abuomara 2018Within 24 h of presentation*******Good quality
Biering-Sørensen 2013Within 5 days of admission********Good quality
Hole 2003Between 2 and 7 days after AMI*****Fair quality
Karvounis 2004Within 24 h of admission and repeated 1 month after AMI******Good quality
Møller 2001Within 24 h of admission, then on day 5, 1 and 3 months post-AMI****Fair quality
Møller 2003Within 6 days of AMI********Good quality
Rahman 2009Unclear*****Good quality
Sasao 2004Within 1 h of angioplasty*******Good quality
Schwammenthal 2003Within 24 h of hospital admission********Good quality
Souza 2011Within 24 h of arrival at coronary care unit, within 48 h of chest pain******Good quality
Szymanski 200214 ± 2 days post-AMI*******Good quality
Uzunhasan 2006Within 24 h of admission*****Good quality
Westholm 2013Median time 3(2–4) days from admission******Good quality
Yilman 2004Within 24 h of admission*******Good quality
Yuasa 2005At time of admission*******Fair quality
Zamfir 2016Within hospitalisation stay of AMI******Good quality

aSelection domain based on: (1) Representativeness of exposed cohort, (2) Selection of the non-exposed cohort, (3) Ascertainment of exposure, 4) Demonstration that outcome of interest was not present at the start of the study; a star (*) is awarded for each of the criteria meet, a maximum of 4 stars can be awarded for this domain; bComparability domain based on: comparability of cohorts on the basis of the design of analysis – *Control for age, **Control for other factors; cOutcome domain based on: (1) Assessment of outcome, (2) Was follow-up long enough for outcomes to occur, (3) Adequacy of follow-up of cohorts.

AMI, acute myocardial infarction; LV, left ventricle.

Table 3

Tei index cut off values, outcomes and prognostic use of Tei index.

Study ID

Tei index abnormal cut off values

Tei index and outcomes

Tei index prognostically useful?

Abuomara 2018>0.73Tei Index with and without heart failure:

0.88 ± 0.18 vs 0.58 ± 0.11, P = 0.0001.

Heart failure with Tei Index >0.73: sensitivity 78.3%, specificity 94.6%.
Yes, able to predict development of heart failure
Biering-Sørensen 20130.59 ± 0.16Tei Index with and without major adverse outcome: 0.59 ± 0.16 vs 0.52 ± 0.13, P<0.001.Yes, able to predict development of heart failure, future hospitalisation, reinfarction and mortality
Hole 2003N/ATei Index was a significant predictor of major adverse outcome, but not for the development of heart failure or death.No, not able to predict heart failure episodes.
Karvounis 2004N/AControl vs Killip class I vs Killip class II and III:

Tei Index at day 1: 0.330 ± 0.080 vs 0.344 ± 0.084 vs 0.686 ± 0.120, P < 0.0001.

Tei Index At 1 month: 0.330 ± 0.080 vs 0.329 ± 0.080 vs 0.649 ± 0.110, P < 0.0001.
Yes, associated with mortality.
Møller 2001>0.63One-year survival in patients with Tei Index <0.63 was 89% compared to 37% in patients with index ≥0.63, P < 0.0001.

Cardiac death with Tei Index >0.63: RR 5.6 (2.4–13.0), P < 0.0001.
Yes, able to predict LV dilatation and mortality.
Møller 2003N/AMultivariable predictors of all-cause deaths according to Tei index:

Tei index < 0.46: ref.

Tei index 0.46–0.55: aRR 2.1 (1.2–3.6), P = 0.001.

Tei index 0.56–0.68: aRR 2.3 (1.5–3.9), P = 0.001.

Tei index > 0.68: aRR 4.0 (2.1–11.6), P < 0.0001.
Yes, independent predictor of morality.
Rahman 2009>0.40Prediction of cardiac complications:

Tie index of >0.40 sensitivity 86%, specificity 82%, accuracy 83%.

Tei Index and hazards ratios for complications:

Cardiogenic shock: HR 2.5 (1.7–3.6), P = 0.008.

Cardiac death: HR 2.0 (1.4–2.9), P = 0.30.

Revascularisation: HR 2.0 (1.6–2.7), P = 0.023.

Readmission: HR 1.3 (1.1–1.4), P = 0.016.

Congestive heart failure: HR 2.0 (1.6–2.7), P = 0.041.

Secondary arrhythmias: HR 1.5 (1.1–1.9), P = 0.32.

Advanced atrioventricular block: HR 1.4 (1.2–1.7), P = 0.03.
Yes, independent predictor of cardiac complications (excluding secondary arrhythmia’s).
Sasao 2004>0.70Tei index significantly higher in acute myocardial infarction patient’s vs controls: 0.630 vs 0.375, P < 0.0001.

Tei index >0.70 was significantly correlated with cardiac events (cardiac death or congestive heart failure): OR 14.139 (1.269–157.553), P = 0.0313.
Yes, significantly associated with development of heart failure and mortality but only when LVEF <45% in patients >60 years.
Schwammenthal 2003>0.52Multivariable predictor of death, congestive heart failure and reinfarction:

Tei Index ≥0.52: OR 1.09 (0.59–2.14).

LVEF <40%: OR 3.82 (2.15–6.87).
No, not able to predict development of heart failure, reinfarction or mortality.
Souza 2011Independent predictor of in-hospital congestive heart failure events:

Left ventricular ejection fraction ≤45%: OR 17.0 (4.1–70.8), P < 0.0001.

Age ≥60 and Tei index <0.57: OR 0.5 (0.1–4.1).

Age ≥60 and Tei index ≥0.57: OR 13.7 (2.7–68.6), P = 0.02
Yes, independent predictor for development of in-hospital heart failure.
Szymanski 2002>0.55Cardiac deaths and nonfatal recurrent myocardial infarction with Tei index >0.55 aRR 4.45 (1.28–15.45), P = 0.019.Yes, independent predictor for mortality or reinfarction.
Uzunhasan 2006Heart failure: >0.76 ± 0.27

Mortality: 0.60 ± 0.32
AMI patients (n = 77), controls (n = 88)

High (>0.60) vs low (<0.60) Tei index:

Death: 12 (30.8%) vs 1 (2.6%).

Heart failure: 19 (48.7%) vs 3 (7.9%).

Mean Tei index of surviving vs dead patients: 0.61 ± 0.1 vs 0.7 ± 0.1, P = 0.001.
Yes, indictor for development of heart failure, LV dysfunction and mortality.
Westholm 2013N/AROC analysis with AUC for Tei Index SD vs Tei Index Delta vs Simpson LVEF in respect to death: 0.65 (0.56–0.74) vs 0.64 (0.55–0.73) vs 0.73 (0.65–0.81).No, no significant prognostic information derived.
Yilmaz 2004>0.60Left ventricular thrombus formation prediction had a sensitivity of 81%, specificity of 73%, positive predictive value of 62%, negative predictive value of 88%.Yes, able to predict development of LV thrombus.
Yuasa 2005>0.59Multivariate predictors of complications (left ventricular aneurysm, heart failure, shock, paroxysmal atrial fibrillation, cardiac death, ventricular tachycardia/ventricular fibrillation, pericardial effusion, cardiac rupture, advanced atrioventricular block).Yes, able to predict complications of AMI.
Zamfir 2016N/ARV Tei index was the only parameter to correlated with major adverse cardiac events.Yes, able to predict development of heart failure, reinfarction, need for re-vascularisation and mortality.

AUC, area under the curve; ROC, rceiver operating characteristics.

Tei index and mortality studies

In the study by Karvounis et al., Tei index was greater among patients with Killip class II and III compared to Killip class I at both 1 day follow-up and 1 month follow-up. The mortality rate at 1 year was higher with Killip class II and III compared to class I (24). For survival, Møller et al. found that survival at 1 year was 89% among patients with a Tei index <0.63 compared to 37% with a Tei index ≥0.63. Here, Tei index was associated with an increased risk of cardiac death (RR 5.6 95% CI 2.4–13.0) (15). Møller et al. also showed that at a median follow-up duration of 34 months, relative to a Tei index of <0.46, there was a two-fold increase in the risk of death with a Tei index value of between 0.46 and 0.68 and a four-fold increase in the risk of death with a Tei index value >0.68 (15). Szymanski et al. found that a Tei index >0.55 was associated with a four-fold increase in the risk of cardiac death and nonfatal recurrent myocardial infarction (14). Uzunhasan et al. found that Tei index was greater among patients with death and heart failure (26).

Tei index and heart failure studies

Abuomara et al. evaluated the value of a Tei index >0.73 compared to a LVEF ≤33% and found that the Tei index was more sensitive (78.3% vs 56.5%) with similar specificity (94.6% vs 94.6%) for in-hospital heart failure after AMI (6). Sasao et al. concluded that a greater Tei index (reported as >0.70) was correlated with the development of heart failure episodes (OR 14.139 95% CI 1.269–157.553) (18). Schwammenthal et al. found that Tei index ≥0.52 was not predictive of adverse outcomes whilst an LVEF <40% was associated with adverse outcomes (19). Souza et al. found that an LVEF ≤45% was associated with increased odds of in-hospital heart failure but only amongst patients ≥60 years of age with a Tei index ≥0.57 (25).

Tei index and composite adverse outcomes

Biering Sørensen et al. reported that a greater Tei index value (0.59 ± 0.16 vs 0.52 ± 0.13, P < 0.001) was associated with major adverse outcomes including congestive heart failure, reinfarction and mortality (22). Similarly, over a 2-year follow-up duration Hole et al. found that Tei index was a better predictor of major adverse outcome compared to baseline LVESI and EDT but Tei index was not a better predictor of heart failure or death (23). Rahman et al. found that a Tei index value >0.40 had better sensitivity (86% vs 65%), specificity (82% vs 50%) and accuracy (83% vs 58%) compared to LVEF <40% for predicting cardiac complications including cardiogenic shock, revascularisation, readmissions, congestive heart failure and advanced atrioventricular heart block (17). Westholm et al. found that Tei index did not have a better AUC for predicting adverse outcomes compared to Simpson’s biplane LVEF (20). In the evaluation of left ventricular intra-cavity thrombus formation, Yilmaz et al. reported that a Tei index value >0.60 had good sensitivity (81%) and specificity (73%) and was significantly predictive of thrombus formation when compared to ejection fraction. Yuasa et al. found that the AUC analysis of a Tei index value ≥0.59 had similar AUC as ejection fraction <45% for 30-day complications (27). Zamfir et al. found that RV Tei index was the only parameter which significantly correlated with reinfarction, need for revascularisation and heart failure and death during the AMI hospitalisation (OR 9.17 95% CI 1.03–83.7) (29).

Discussion

Our review on Tei index and its predictive value in morbidity and mortality events in AMI patients have several key findings. First, several studies indicate that a greater Tei index value can predict morbidity and mortality events during both the initial hospitalisation period and follow-up period ranging from 30 days to 57 months. Second, there is no consistency of what constituents a greater, or abnormal, Tei index value. The most appropriate timing of Tei index evaluation is also not known. Thirdly, it is not certain whether the use of the Tei index has any advantage over the more utilised echocardiographic measurement of LVEF and the more recent addition of global longitudinal strain imaging. More studies are needed in order to better understand Tei index before its routine incorporation into every day clinical practice.

The studies included in this review had several key differences making it challenging to assess the prognostic value of Tei index in AMI patients. Suggesting an appropriate ‘abnormal’ cut off value for Tei index is challenging for a number of reasons. First, in this review, Tei index values were assessed at varying times throughout the initial hospitalisation period with differing ‘abnormal’ cut of values being applied. Even in the five studies (6, 19, 24, 26, 27), where Tei index was assessed within 24 h of AMI ‘abnormal’ Tei index ‘abnormal’ values ranged from >0.60 (27), 0.686 ± 0.12 (24), >0.70 (26), and >0.73 (6). Identifying an appropriate ‘abnormal’ Tei index cut off range in AMI patients is also further compounded by the fact that the original research, whereby a normal Tei index value of <0.39 ± 0.5 was derived, likely differs from the cohort of patients seen in this review. The original study by Tei et al. (1), was based on a cohort of 170 adult participants, 70 of which had a normal LVEF, whereas the remaining 100 participants were known to have a dilated cardiomyopathy of varying severities (LVEF ranging from 30 to 50%), the breakdown of the underlying pathology, however, is not clear. Future studies are needed to clarify the optimal timing for when Tei index should be assessed along with systematically determining a Tei index ‘abnormal’ cut off value which is best associated with adverse outcomes. The follow-up duration also varied vastly from the inclusion of the initial hospitalisation period only right up to 58 months post-AMI event. The use of different study end points was also apparent which included: mortality, reinfarction, left ventricular thrombus formation, tachyarrhythmia’s, bradyarrhythmia’s and heart failure episodes.

Current recommendations incorporate the use of LVEF and echocardiography assessment within 24–48 h of an AMI which enables patients to be risk-stratified and appropriately managed (9). Global longitudinal strain has also been shown to provide prognostic importance in AMI patients (30). However, the use of LVEF via Simpson’s biplane and global longitudinal strain is reliant on adequate 2D endocardial border definition in non-foreshortened views. The Tei index is an easy measure of cardiac function which has the added advantage that it does not rely solely on adequate 2D image quality. This is important as Tei index could be used in patients where 2D/3D LVEF or global longitudinal strain are impossible due to poor endocardial definition. Furthermore, LVEF is hinder by inter and intraobserver variability, geometric assumptions, is pre and after-load dependent and is affected by the presence of variable and high heart rates (30). While there is limited evidence about the inter-observer variability of the Tei index measurements, the inter-observer variability is probably lower than that of either the left ventricular ejection fraction or global longitudinal strain measurements. Moreover, Tei index may be an attractive alternative quantification measurement as it has been shown to be independent of pre and after-load, heart rate and geometric assumptions (15). Thus, Tei index has the potential to be a more reproducible and reliable quantification measure with the added benefit of not being heavily reliance on the endocardial definition and adequate 2D image quality. The appropriate timing of Tei index remains unknown, it is also unsure of whether a higher Tei index value would be required if evaluation is performed within the first 24–48 h post-AMI.

This review highlights the potential importance of an ‘abnormal’ Tei index value and its prognostic benefit to patients which is in keeping with the known prognostic value of Simpson’s biplane LVEF. There are some studies where the Tei index was found to be more sensitive, specific and accurate in comparison to LVEF in predicting morbidity and mortality events (6, 17, 27), however, each of these studies differed in terms of study end points, follow-up period as well as using differing Tei index cut off values. However, when a high Tei index was considered together with a reduced LVEF, there were studies to suggested Tei index does not yield additional prognostic information over LVEF alone. Nevertheless, when the LVEF was greater than 45% its prognostic value to predict adverse outcomes reliably is limited (31). The measurement of a ‘abnormal’ and high Tei index value in patients with mildly reduced or normal LVEF may highlight a previously undetected cohort of patients who are at a high risk of adverse events. Similarly, the finding of a reduced LVEF and low Tei index value may allow for further refinement in risk stratification of high-risk patients.

Studies have demonstrated myocardial recovery following an AMI event which can be easily detected with an improvement in Simpson’s biplane LVEF (9). There is limited information on whether Tei index showed a similar improvement over time. Hole et al. and Karvounis et al. were the only two studies which assessed Tei index at baseline and follow-up the results of both indicated there to be no significant change. This was also irrespective of whether Tei index was high or not at baseline (23, 24). The clinical relevance of an improvement in Tei index over time remains unknown.

Karvounis et al. (24) was the only study to report on the individual components of Tei index. In this study, there was no change in the isovolumetric relaxation time at baseline and at one-month follow-up, this was irrespective of whether there were signs of heart failure or not in the included patient cohort. This study did not evaluate isovolumetric contraction.

This review highlights the small number of fair and good quality studies investigating Tei index in AMI patients. The strengths of the review are that it included only full studies with abstracts and case reports being excluded and all studies were prospective in design with well-defined patient outcome end points. Several studies included all coronary territory AMI events with only three studies being selective of anterior or anteroseptal AMI’s. This enables the results to be more applicable to a wider patient cohort. In addition, the studies are representative of the AMI cohort that is seen in clinical practice with a male predominance. Limitations of this review include the small sample sizes with the largest study involving 417 patients, there were large variations in follow-up duration of patients. Patients were also managed differently which included being medically managed or receiving percutaneous coronary intervention which was performed either on admission or within 48 h of AMI event.

Several questions remain unanswered related to the role of Tei index in patients with AMI. Future large prospective studies should aim to determine an acceptable ‘abnormal’ cut off value for Tei index which is of a prognostic benefit to patients. The role of Tei index together with other measures such as 2D/3D LVEF and global longitudinal strain analysis in post-AMI patients merits further investigation over a short and long-term follow-up period. The importance of a greater high Tei index value in patients with mildly impaired or a normal LVEF and a low Tei index value in patients with moderate or severely impaired LVEF should be investigated. In addition, the prognostic value of right ventricular myocardial performance in AMI patients should also be evaluated.

In conclusion, the studies in the literature suggest that the Tei index has value in identifying patients who have a greater propensity for adverse events after AMI. However, more studies are needed to determine how Tei index should be used before its routine inclusion within the clinical practice as there is uncertainly to its additional value over well-established parameters such as LVEF.

Supplementary materials

This is linked to the online version of the paper at https://doi.org/10.1530/ERP-20-0017.

Declaration of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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  • 3

    Karatzis EN, Giannakopoulou AT, Papadakis JE, Karazachos AV & Nearchou NS Myocardial performance index (Tei index): evaluating its application to myocardial infarction. Hellenic Journal of Cardiology 2009 50 6065.

    • Search Google Scholar
    • Export Citation
  • 4

    Kim WH, Otsuji Y, Yuasa T, Minagoe S, Seward JB & Tei C Evaluation of right ventricular dysfunction in patients with cardiac amyloidosis using Tei index. Journal of the American Society of Echocardiography 2004 17 4549. (https://doi.org/10.1016/j.echo.2003.09.006)

    • Search Google Scholar
    • Export Citation
  • 5

    Nunes MC, Barbosa MM, Ribeiro ALP, Colosimo EA & Rocha MOC Left atrial volume provides independent prognostic valve in patients with Chagas cardiomyopathy. Journal of the American Society of Echocardiography 2009 22 8288. (https://doi.org/10.1016/j.echo.2008.11.015)

    • Search Google Scholar
    • Export Citation
  • 6

    Abuomara HZA, Hassan OM, Rashid T & Baraka M Myocardial performance index as an echocardiographic predictor of early in-hospital heart failure during first acute anterior ST-elevation myocardial infarction. Egyptian Heart Journal 2018 70 7175. (https://doi.org/10.1016/j.ehj.2017.12.001)

    • Search Google Scholar
    • Export Citation
  • 7

    Migrino RQ, Young JB, Ellis SG, White HD, Lundergan CF, Miller DP, Granger CB, Ross AM, Califf RM & Topol EJ End-systolic volume index at 90 to 180 minutes into reperfusion therapy for acute myocardial infarction is a strong predictor of early and late mortality. The global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO)-I angiographic investigators. Circulation 1997 96 116121. (https://doi.org/10.1161/01.cir.96.1.116)

    • Search Google Scholar
    • Export Citation
  • 8

    Sutton MStJ, Pfeffer MA, Plappert T, Rouleau JL, Moyé LA, Dagenais GR, Lamas GA, Klein M, Sussex B & Goldman S Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation 1994 89 6875. (https://doi.org/10.1161/01.cir.89.1.68)

    • Search Google Scholar
    • Export Citation
  • 9

    Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K & Kastrati A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. European Heart Journal 2008 29 29092945. (https://doi.org/10.1093/eurheartj/ehn416)

    • Search Google Scholar
    • Export Citation
  • 10

    Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA & Mullany CJ et al. 2007 Focused update of the ACC/AHA 2004 Guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing group to review new evidence and update the ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction). Journal of the American College of Cardiology 2008 51 210247.

    • Search Google Scholar
    • Export Citation
  • 11

    Møller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ & Pillikka PA Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. American Heart Journal 2006 151 419425. (https://doi.org/10.1016/j.ahj.2005.03.042)

    • Search Google Scholar
    • Export Citation
  • 12

    Burns RJ, Gibbons RJ, Yi Q, Roberts RS, Miller TD, Schaer GL, Anderson JL, Yusuf SCORE Study Investigators. The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. Journal of the American College of Cardiology 2002 39 3036. (https://doi.org/10.1016/s0735-1097(0101711-9)

    • Search Google Scholar
    • Export Citation
  • 13

    Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Boersma E, Holman ER, Van der Wall EE, Schalij MJ & Bax JJ Prognostic importance of strain and strain rate after acute myocardial infarction. European Heart Journal 2010 31 16401647. (https://doi.org/10.1093/eurheartj/ehq105)

    • Search Google Scholar
    • Export Citation
  • 14

    Szymański P, Rezler J, Stec S & Budaj A Long-term prognostic value of an index of myocardial performance in patients with myocardial infarction. Clinical Cardiology 2002 24 378383.

    • Search Google Scholar
    • Export Citation
  • 15

    Møller JE, Sondergaard E, Poulsen SH & Egstrup K The Doppler echocardiographic myocardial performance index predicts left-ventricular dilation and cardiac death after myocardial infarction. Cardiology 2001 95 105111. (https://doi.org/10.1159/000047355)

    • Search Google Scholar
    • Export Citation
  • 16

    Møller JE, Egstrup K, KØber L, Poulsen SH, Nyvas O & Torp-Pederson C Prognostic importance of systolic and diastolic function after acute myocardial infarction. American Heart Journal 2003 145 147153. (https://doi.org/10.1067/mhj.2003.46)

    • Search Google Scholar
    • Export Citation
  • 17

    Rahman N, Kazmi KA & Yousaf M Non-invasive prediction of ST elevation myocardial infarction complications by left ventricular Tei index. Journal of the Pakistan Medical Association 2009 59 7578.

    • Search Google Scholar
    • Export Citation
  • 18

    Sasao H, Noda R, Hasegewa T, Endo A, Oimatsu H & Takada T Prognostic value of the Tei index combining systolic and diastolic myocardial performance in patients with acute myocardial infarction treated by successful primary angioplasty. Heart and Vessels 2004 19 6874. (https://doi.org/10.1007/s00380-003-0735-7)

    • Search Google Scholar
    • Export Citation
  • 19

    Schwammenthal E, Adler Y, Amichai K, Sagie A, Behar S, Hod H & Feinberg MS Prognostic value of global myocardial performance indices in acute myocardial infarction: comparison to measures of systolic and diastolic left ventricular function. Chest 2003 124 16451651. (https://doi.org/10.1378/chest.124.5.1645)

    • Search Google Scholar
    • Export Citation
  • 20

    Westholme C, Johnson J, Jernburg T & Winter R The prognostic value of mechanical left ventricular dyssynchorny in patients with acute coronary syndrome. Cardiovascular Ultrasound 2013 11 35. (https://doi.org/10.1186/1476-7120-11-35)

    • Search Google Scholar
    • Export Citation
  • 21

    Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M & Tugwell P The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. Ottowa, Canada: Ottawa Hospital Research Institute, 2000. (available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp)

    • Search Google Scholar
    • Export Citation
  • 22

    Biering-Sørensen T, Mogelvang R, Søgaard P, Pedersen SH, Galatius S, Jørgensen PG & Jensen JS Prognostic value of cardiac time intervals by tissue Doppler imaging M-mode in patients with acute ST-segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. Circulation: Cardiovascular Imaging 2013 6 457465. (https://doi.org/10.1161/CIRCIMAGING.112.000230)

    • Search Google Scholar
    • Export Citation
  • 23

    Hole T & Skjærpe T Myocardial performance index (Tei index) does not reflect long-term changes in left ventricular function after acute myocardial infarction. Echocardiography 2003 20 1–7. (https://doi.org/10.1046/j.1540-8175.2003.00001.x)

    • Search Google Scholar
    • Export Citation
  • 24

    Karvounis HI, Nouskas IG, Farmakis TM, Vrogistinos KM, Papadopoulos CE, Zaglavara TA, Parharidis GE & Louridas GE Evaluation of a Doppler-derived index combining systolic and diastolic left ventricular function in acute myocardial infarction. Angiology 2004 55 2128. (https://doi.org/10.1177/000331970405500104)

    • Search Google Scholar
    • Export Citation
  • 25

    Souza LP, Campos O, Peres CA, Machado CV & Carvalho AC Echocardiographic predictors of early in hospital heart failure during first ST elevating acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function? Cardiovascular Ultrasound 2011 9 17. (https://doi.org/10.1186/1476-7120-9-17)

    • Search Google Scholar
    • Export Citation
  • 26

    Uzunhasan I, Bader K, Okςun B, Hatemi AC & Mutlu H Correlation of the Tei index with left ventricular dilatation and mortality in patients with acute myocardial infarction. International Heart Journal 2006 47 331342. (https://doi.org/10.1536/ihj.47.331)

    • Search Google Scholar
    • Export Citation
  • 27

    Yilmaz R, Celik S, Baykan M, Orem C, Kasap H, Durmus I & Erdol C Pulse wave tissue Doppler-derived myocardial performance index for the assessment of left ventricular thrombus formation risk after acute myocardial infarction. American Heart Journal 2004 148 11021108. (https://doi.org/10.1016/j.ahj.2004.05.025)

    • Search Google Scholar
    • Export Citation
  • 28

    Yusas T, Otsuji Y, Kuwahara E, Takasaki K, Yoshifuku S, Yuge K, Kisanuki A, Toyonaga K, Lee S & Toda H et al. Noninvasive prediction of complications with anteroseptal acute myocardial infarction by left ventricular Tei index. Journal of the American Society of Echocardiography 2005 18 2025. (https://doi.org/10.1016/j.echo.2004.08.034)

    • Search Google Scholar
    • Export Citation
  • 29

    Zamfir D, Pitic D, Tamasescu G, Onciul S, Tăutu O, Angelescu C, Onut R, Stoian M & Dorobantu M Prognostic value of right ventricular function assessed by echocardiography in patients presenting with a first acute ST elevation myocardial infarction treated by primary PCI. Revista Medico-Chirurgicala a Societatii de Medici si Naturalisti din Iasi 2016 120 824833.

    • Search Google Scholar
    • Export Citation
  • 30

    Cikes M & Solomon SD Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. European Heart Journal 2016 37 16421650. (https://doi.org/10.1093/eurheartj/ehv510)

    • Search Google Scholar
    • Export Citation
  • 31

    Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK, Warnica JW, Khrakovskaya M, Arnold JM & Schwartz Y et al. Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation 2005 111 34113419. (https://doi.org/10.1161/CIRCULATIONAHA.104.508093)

    • Search Google Scholar
    • Export Citation

 

    British Society of Echocardiography

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1184 1184 60
PDF Downloads 336 336 48
  • 1

    Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ & Seward JB New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function – a study in normals and dilated cardiomyopathy. Journal of Cardiology 1995 26 357366.

    • Search Google Scholar
    • Export Citation
  • 2

    Eto G, Ishii M, Tei C, Tsutsumi T, Akagi T & Kato H Assessment of global left ventricular function in normal children and in children with dilated cardiomyopathy. Journal of the American Society of Echocardiography 1999 12 10581064. (https://doi.org/10.1016/s0894-7317(9970102-1)

    • Search Google Scholar
    • Export Citation
  • 3

    Karatzis EN, Giannakopoulou AT, Papadakis JE, Karazachos AV & Nearchou NS Myocardial performance index (Tei index): evaluating its application to myocardial infarction. Hellenic Journal of Cardiology 2009 50 6065.

    • Search Google Scholar
    • Export Citation
  • 4

    Kim WH, Otsuji Y, Yuasa T, Minagoe S, Seward JB & Tei C Evaluation of right ventricular dysfunction in patients with cardiac amyloidosis using Tei index. Journal of the American Society of Echocardiography 2004 17 4549. (https://doi.org/10.1016/j.echo.2003.09.006)

    • Search Google Scholar
    • Export Citation
  • 5

    Nunes MC, Barbosa MM, Ribeiro ALP, Colosimo EA & Rocha MOC Left atrial volume provides independent prognostic valve in patients with Chagas cardiomyopathy. Journal of the American Society of Echocardiography 2009 22 8288. (https://doi.org/10.1016/j.echo.2008.11.015)

    • Search Google Scholar
    • Export Citation
  • 6

    Abuomara HZA, Hassan OM, Rashid T & Baraka M Myocardial performance index as an echocardiographic predictor of early in-hospital heart failure during first acute anterior ST-elevation myocardial infarction. Egyptian Heart Journal 2018 70 7175. (https://doi.org/10.1016/j.ehj.2017.12.001)

    • Search Google Scholar
    • Export Citation
  • 7

    Migrino RQ, Young JB, Ellis SG, White HD, Lundergan CF, Miller DP, Granger CB, Ross AM, Califf RM & Topol EJ End-systolic volume index at 90 to 180 minutes into reperfusion therapy for acute myocardial infarction is a strong predictor of early and late mortality. The global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO)-I angiographic investigators. Circulation 1997 96 116121. (https://doi.org/10.1161/01.cir.96.1.116)

    • Search Google Scholar
    • Export Citation
  • 8

    Sutton MStJ, Pfeffer MA, Plappert T, Rouleau JL, Moyé LA, Dagenais GR, Lamas GA, Klein M, Sussex B & Goldman S Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation 1994 89 6875. (https://doi.org/10.1161/01.cir.89.1.68)

    • Search Google Scholar
    • Export Citation
  • 9

    Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K & Kastrati A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. European Heart Journal 2008 29 29092945. (https://doi.org/10.1093/eurheartj/ehn416)

    • Search Google Scholar
    • Export Citation
  • 10

    Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA & Mullany CJ et al. 2007 Focused update of the ACC/AHA 2004 Guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing group to review new evidence and update the ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction). Journal of the American College of Cardiology 2008 51 210247.

    • Search Google Scholar
    • Export Citation
  • 11

    Møller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ & Pillikka PA Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. American Heart Journal 2006 151 419425. (https://doi.org/10.1016/j.ahj.2005.03.042)

    • Search Google Scholar
    • Export Citation
  • 12

    Burns RJ, Gibbons RJ, Yi Q, Roberts RS, Miller TD, Schaer GL, Anderson JL, Yusuf SCORE Study Investigators. The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. Journal of the American College of Cardiology 2002 39 3036. (https://doi.org/10.1016/s0735-1097(0101711-9)

    • Search Google Scholar
    • Export Citation
  • 13

    Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Boersma E, Holman ER, Van der Wall EE, Schalij MJ & Bax JJ Prognostic importance of strain and strain rate after acute myocardial infarction. European Heart Journal 2010 31 16401647. (https://doi.org/10.1093/eurheartj/ehq105)

    • Search Google Scholar
    • Export Citation
  • 14

    Szymański P, Rezler J, Stec S & Budaj A Long-term prognostic value of an index of myocardial performance in patients with myocardial infarction. Clinical Cardiology 2002 24 378383.

    • Search Google Scholar
    • Export Citation
  • 15

    Møller JE, Sondergaard E, Poulsen SH & Egstrup K The Doppler echocardiographic myocardial performance index predicts left-ventricular dilation and cardiac death after myocardial infarction. Cardiology 2001 95 105111. (https://doi.org/10.1159/000047355)

    • Search Google Scholar
    • Export Citation
  • 16

    Møller JE, Egstrup K, KØber L, Poulsen SH, Nyvas O & Torp-Pederson C Prognostic importance of systolic and diastolic function after acute myocardial infarction. American Heart Journal 2003 145 147153. (https://doi.org/10.1067/mhj.2003.46)

    • Search Google Scholar
    • Export Citation
  • 17

    Rahman N, Kazmi KA & Yousaf M Non-invasive prediction of ST elevation myocardial infarction complications by left ventricular Tei index. Journal of the Pakistan Medical Association 2009 59 7578.

    • Search Google Scholar
    • Export Citation
  • 18

    Sasao H, Noda R, Hasegewa T, Endo A, Oimatsu H & Takada T Prognostic value of the Tei index combining systolic and diastolic myocardial performance in patients with acute myocardial infarction treated by successful primary angioplasty. Heart and Vessels 2004 19 6874. (https://doi.org/10.1007/s00380-003-0735-7)

    • Search Google Scholar
    • Export Citation
  • 19

    Schwammenthal E, Adler Y, Amichai K, Sagie A, Behar S, Hod H & Feinberg MS Prognostic value of global myocardial performance indices in acute myocardial infarction: comparison to measures of systolic and diastolic left ventricular function. Chest 2003 124 16451651. (https://doi.org/10.1378/chest.124.5.1645)

    • Search Google Scholar
    • Export Citation
  • 20

    Westholme C, Johnson J, Jernburg T & Winter R The prognostic value of mechanical left ventricular dyssynchorny in patients with acute coronary syndrome. Cardiovascular Ultrasound 2013 11 35. (https://doi.org/10.1186/1476-7120-11-35)

    • Search Google Scholar
    • Export Citation
  • 21

    Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M & Tugwell P The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. Ottowa, Canada: Ottawa Hospital Research Institute, 2000. (available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp)

    • Search Google Scholar
    • Export Citation
  • 22

    Biering-Sørensen T, Mogelvang R, Søgaard P, Pedersen SH, Galatius S, Jørgensen PG & Jensen JS Prognostic value of cardiac time intervals by tissue Doppler imaging M-mode in patients with acute ST-segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. Circulation: Cardiovascular Imaging 2013 6 457465. (https://doi.org/10.1161/CIRCIMAGING.112.000230)

    • Search Google Scholar
    • Export Citation
  • 23

    Hole T & Skjærpe T Myocardial performance index (Tei index) does not reflect long-term changes in left ventricular function after acute myocardial infarction. Echocardiography 2003 20 1–7. (https://doi.org/10.1046/j.1540-8175.2003.00001.x)

    • Search Google Scholar
    • Export Citation
  • 24

    Karvounis HI, Nouskas IG, Farmakis TM, Vrogistinos KM, Papadopoulos CE, Zaglavara TA, Parharidis GE & Louridas GE Evaluation of a Doppler-derived index combining systolic and diastolic left ventricular function in acute myocardial infarction. Angiology 2004 55 2128. (https://doi.org/10.1177/000331970405500104)

    • Search Google Scholar
    • Export Citation
  • 25

    Souza LP, Campos O, Peres CA, Machado CV & Carvalho AC Echocardiographic predictors of early in hospital heart failure during first ST elevating acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function? Cardiovascular Ultrasound 2011 9 17. (https://doi.org/10.1186/1476-7120-9-17)

    • Search Google Scholar
    • Export Citation
  • 26

    Uzunhasan I, Bader K, Okςun B, Hatemi AC & Mutlu H Correlation of the Tei index with left ventricular dilatation and mortality in patients with acute myocardial infarction. International Heart Journal 2006 47 331342. (https://doi.org/10.1536/ihj.47.331)

    • Search Google Scholar
    • Export Citation
  • 27

    Yilmaz R, Celik S, Baykan M, Orem C, Kasap H, Durmus I & Erdol C Pulse wave tissue Doppler-derived myocardial performance index for the assessment of left ventricular thrombus formation risk after acute myocardial infarction. American Heart Journal 2004 148 11021108. (https://doi.org/10.1016/j.ahj.2004.05.025)

    • Search Google Scholar
    • Export Citation
  • 28

    Yusas T, Otsuji Y, Kuwahara E, Takasaki K, Yoshifuku S, Yuge K, Kisanuki A, Toyonaga K, Lee S & Toda H et al. Noninvasive prediction of complications with anteroseptal acute myocardial infarction by left ventricular Tei index. Journal of the American Society of Echocardiography 2005 18 2025. (https://doi.org/10.1016/j.echo.2004.08.034)

    • Search Google Scholar
    • Export Citation
  • 29

    Zamfir D, Pitic D, Tamasescu G, Onciul S, Tăutu O, Angelescu C, Onut R, Stoian M & Dorobantu M Prognostic value of right ventricular function assessed by echocardiography in patients presenting with a first acute ST elevation myocardial infarction treated by primary PCI. Revista Medico-Chirurgicala a Societatii de Medici si Naturalisti din Iasi 2016 120 824833.

    • Search Google Scholar
    • Export Citation
  • 30

    Cikes M & Solomon SD Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. European Heart Journal 2016 37 16421650. (https://doi.org/10.1093/eurheartj/ehv510)

    • Search Google Scholar
    • Export Citation
  • 31

    Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK, Warnica JW, Khrakovskaya M, Arnold JM & Schwartz Y et al. Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation 2005 111 34113419. (https://doi.org/10.1161/CIRCULATIONAHA.104.508093)

    • Search Google Scholar
    • Export Citation