Key result
TDI-MPI and PWD-MPI showed poor clinical agreement and no significant difference in diagnostic accuracy for isolated diastolic dysfunction (AUC 0.68 vs 0.70, P=0.77).
Why the study?
The study sought to determine the diagnostic accuracy and degree of agreement between traditional PWD-MPI and TDI-MPI in patients with grade-I diastolic dysfunction and normal ejection fraction.
Does myocardial performance index measured by tissue Doppler imaging or traditional pulsed-wave Doppler accurately diagnose isolated grade-I diastolic dysfunction in hypertensive patients?
Cross-Sectional (n=98)
Does myocardial performance index measured by tissue Doppler imaging or traditional pulsed-wave Doppler accurately diagnose isolated grade-I diastolic dysfunction in hypertensive patients?
Effect estimate: AUC difference 0.02 (95% CI -0.11 to 0.14)
Absolute Event Rate: 0.68% vs 0.7%
p-value: p=0.77
Neither traditional nor tissue Doppler-derived myocardial performance indices are reliable parameters for assessing isolated left ventricular diastolic dysfunction due to poor diagnostic accuracy and clinical agreement.
Neither MPI reliably diagnoses isolated diastolic dysfunction; leaves open need for validated indices in prospective studies.
AIMS: The Doppler-derived myocardial performance index (MPI) has been considered as a diagnostic and prognostic Doppler marker for many different clinical conditions. The purpose of this study was to determine the diagnostic accuracy of traditional Pulsed-wave Doppler (PWD-MPI) and Pulsed-wave tissue Doppler imaging (TDI-MPI) and the degree of agreement between these methods in patients with grade-I diastolic dysfunction (DDI) and a normal ejection fraction. METHODS: Forty-seven consecutive ambulatory patients with DDI were compared to 51 healthy subjects with normal echocardiograms. All subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI. RESULTS: TDI-MPI and PWD-MPI were significantly higher in patients with DDI than in control subjects: 0.49 ± 0.14 vs. 0.40 ± 0.09 (P < 0.001) and 0.45 ± 0.11 vs. 0.37 ± 0.08 (P < 0.001), respectively. Cutoff values of TDI-MPI > 0.42 and PWD-MPI > 0.40 identified DDI subjects, with sensitivities of 74 and 64%; specificities of 61 and 69%; positive likelihood ratios of 1.9 and 2.0; and negative likelihood ratios of 0.42 and 0.53, respectively; no significant difference was noted between the areas under the ROC curves of TDI-MPI and PWD-MPI (P = 0.77). Bland-Altman plots showed wide limits of agreement between these indices: - 0.17 to 0.23 in healthy subjects and - 0.24 to 0.32 in DDI patients. CONCLUSION: PWD-MPI and TDI-MPI showed poor clinical agreement and were not reliable parameters for the assessment of left ventricular diastolic function.
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Fernandes et al. (2019) conducted a cross-sectional in Isolated diastolic dysfunction (n=98). Tissue Doppler imaging-derived myocardial performance index (TDI-MPI) vs. Conventional pulsed-wave Doppler-derived myocardial performance index (PWD-MPI) was evaluated on Area under the ROC curve (AUC) for diagnosis of diastolic dysfunction (AUC difference 0.02, 95% CI -0.11 to 0.14, p=0.77). TDI-MPI and PWD-MPI showed poor clinical agreement and no significant difference in diagnostic accuracy for isolated diastolic dysfunction (AUC 0.68 vs 0.70, P=0.77).
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