The Clinical Study Of Doppler Tei Index For Evaluating Left Ventricular Global Function In Patients With Chronic Cardiac Insufficiency

Objective To study the correlation of Tei index with clinical cardiac function classification,cardiac functional parameters(left ventricular ejection fraction (EF), E/A ratio)and left ventricular structure parameters(LVDd, RWT), and analysis receiver operating characteristic curve (ROC) ,exploring the value of Tei index for evaluating left ventricular global function in patients with chronic cardiac insufficiency.Methods 73 cases with chronic cardiac insufficiency (40 male, 33 female, age between 23～80, mean age of 54.7±13.0 years old)were admitted to the study. the study population consisted of 23cases with dilated cardiomyopathy, 28 cases with hypertensive heart disease, 22 cases with ischemic cardiomyopathy; All the cases were divided into four groups according to cardiac function classification ( the New York Heart Association ): class I, II, III and IV were respectively named Group I(16 cases), II(20 cases), III(22 cases), IV(15 cases), and 40 healthy cases were admitted to control group(21 male , 19 female, aged between 24～70, mean age of 52.1±9.8 years old). Interventricular septum end-diastole thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end-diastolic dimension (LVDd) and left ventricular end-systolic dimension (LVDs) were measured by M-mode ultrasonography, and calculated EF,left ventricular mass (LVM),relative left ventricular wall thickness (RWT),FS; The mitral and aortic valve flow spectrum were obtained by pulsed Doppler echocardiography, the first, measured the a and b value, calculated left ventricular Tei index, then, measured the early diastolic mitral flow velocity (E),the late diastolic flow velocity (A )and calculated the E / A ratio. Comparing the differences among groups, analysising the correlation of Tei index with clinical cardiac function classification, cardiac functional parameters (EF, E/A ratio )and left ventricular structure parameters(LVDd, RWT) in patients with chronic heart insufficiency. Analysising receiver operating characteristic curve (ROC) and comparing specificity and sensitivity among Tei index, EF and the E/A ratio in separating the presence or absence of chronic cardiac insufficiency. Results①With NYHA functional class increased,left ventricular Tei index of patients with chronic heart insufficiency increased gradually, and correlated with NYHA functional classification.②Left ventricular Tei index of each group of patients with chronic heart insufficiency were higher than the normal control group (P<0.05), left ventricular Tei index of groups III, IV were increased significantly (P<0.05), but no significance between group III and group IV (P> 0.05).③With NYHA functional classification increased,it takes on a reduced tendency of EF, EF of II, III, IV group reduced obviously than control group, and there was no obvious difference between group I and control group (P> 0.05).④The E/A ratios of group I and group II were lower than control group (P <0.05),and the E/A ratio <1, E/A ratios of group IV was increased obviously than control group (P <0.05), and there was no statistically significance between group III and control group.⑤Tei index in patient with chronic cardiac insufficiency has a negtive correlation with EF,FS,RWT ( r=-0.68, P<0.01,r=-0.67, P<0.01 and r=-0.64, P<0.01),but has a positive correlation with LVDd,LVDs (r=0.67,P<0.01 and r=0.72,P<0.01)。⑥Receiver operating characteristic curve (ROC) analysis for separation of the presence or absence of chronic cardiac insufficiency. The area under the receiver operating characteristics curve (mean±S) was 0.98±0.02 for the Tei-Index and 0.90±0.03 for the ejection fraction. Using that cutpoint of Tei index>0·45, chronic cardiac insufficiency was identified with a sensitivity of 89% and a specificity of 90%, But using that cutpoint of EF<50%, chronic cardiac insufficiency was identified with a sensitivity of 70% and a specificity of 100%, But the E/A ratio did not distinguish between patients with and without chronic cardiac insufficiency.Conclusion①The Tei index can evaluate left ventricular global function of patients with chronic heart insufficiency.②The Tei index can be used to distinguish whether people exists chronic cardiac insufficiency and was better than EF, the E/A ratio in clinical application.③There has a better correlation between the Tei index and LVDd,IVST, RWT.④The Tei index is easily obtained, did not require complicated instrumentation and it can evaluate comprehensively left ventricular systolic function and diastolic function of patients with chronic cardiac insufficiency, which is a Doppler index fitting for most of hospitals to apply.