What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Pseudonormal/restrictive mitral flow (n=33). Intervention: TEI index vs. Other echocardiographic indices of LV function. Primary outcome: Diagnosis of pseudonormal/restrictive mitral flow (defined as LV mid-diastolic pressure >12 mmHg) (AUC 0.95, 95% CI 0.88-1.0, p=<0.0001).

January 1, 2002Circulation Journal30 citationsOpen Access

Noninvasive Differentiation of Normal From Pseudonormal/Restrictive Mitral Flow Using TEI Index Combining Systolic and Diastolic Function.

Q: What are the key findings of this study?

A TEI index ≥0.65 accurately differentiated pseudonormal/restrictive from normal mitral flow with 82% sensitivity, 96% specificity, and an area under the curve of 0.95.

HZHui ZhangShandong Normal University YOYutaka OtsujiKagoshima University KMKeiko MatsukidaKagoshima University

Key Result

A TEI index ≥0.65 accurately differentiated pseudonormal/restrictive from normal mitral flow with 82% sensitivity, 96% specificity, and an area under the curve of 0.95.

Study Design

Type

Cross-Sectional (n=33)

Blinding

Single-blind

Multicenter

Structured PICO

Does the TEI index accurately differentiate pseudonormal/restrictive from normal mitral flow in patients with mitral flow E/A >= 1?

Population

33 patients in sinus rhythm with mitral flow E/A ≥1 undergoing diagnostic catheterization, evaluated to determine the diagnostic accuracy of the TEI index.

Exposure

Doppler echocardiography to calculate the TEI index (sum of isovolumic contraction and relaxation time divided by ejection time).

Comparator

Invasive catheterization measuring LV mid-diastolic pressure > 12 mmHg (reference standard).

Outcome

Diagnostic accuracy (sensitivity, specificity, accuracy) of the TEI index for identifying pseudonormal/restrictive mitral flow, and correlation with LV mid-diastolic pressures.surrogate

The TEI index measured by Doppler echocardiography provides a highly accurate, noninvasive method to differentiate pseudonormal/restrictive from normal mitral flow.

Main Result

Effect estimate: AUC 0.95 (95% CI 0.88-1.0)

p-value: p=<0.0001

Limitations

Doppler echocardiography and cardiac catheterization were not performed simultaneously, though they were within 24 hours.
Small sample size prevented subgroup analysis of patients with impaired left ventricular ejection fraction.
Frequent noise on the ECG prevented analysis of the individual time intervals contributing to the TEI index.

Abstract

Differentiation of normal from pseudonorma/restrictive mitral flow is not necessarily easy. Pseudonormal/restrictive flow is usually associated with left ventricular (LV) dysfunction, which can be detected using the TEI index, combining systolic and diastolic function. The purpose of this study was to test the feasibility of using the TEI index to differentiate pseudonormal/restrictive from normal mitral flow. In 33 patients with mitral flow E/A > or = 1 and LV mid-diastolic pressure measured by catheterization, the LV volumes, mitral E and A velocity, deceleration time of the E velocity, and the TEI index, defined as the sum of the isovolumic contraction and relaxation time divided by ejection time, were evaluated using Doppler echocardiography. Pseudonormal/restrictive mitral flow was defined as mitral flow E/A > or = 1 associated with LV mid-diastolic pressure > 12 mmHg. There were 22 and 11 patients with normal and pseudonorma/restrictive mitral flow, respectively. Among the indices of LV function, the TEI index achieved the best correlation with LV mid-diastolic pressures (r2 = 0.63, p or = 0.65 as the criteria for pseudonormal/restrictive mitral flow, this diagnosis had sensitivity, specificity, and accuracy of 82%, 96%, and 91%, respectively. TEI index allows noninvasive differentiation of pseudonormal /restrictive from normal mitral flow.

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