Journal of the American Society of Echocardiography
Original ArticlesSevere aortic valve stenosis with preserved and reduced systolic left ventricular function: Diagnostic usefulness of the Tei index*
Section snippets
Study population
Of 98 consecutive participants undergoing cardiac catheterization for severe AS (valve orifice ≤ 1 cm2) in our institution (University Essen) between January 1996 and December 1999, those with aortic regurgitation grade II° or greater, mitral regurgitation grade II° or greater, atrial fibrillation, pacemakers, left bundle branch block, or high-grade atrioventricular block were excluded. AS patients with significant coronary artery stenoses who required coronary artery bypass grafting, also were
Clinical data and hemodynamic measurements
Patient demographics are given in Table 1.CON, DAS, and PAS patients did not differ significantly with respect to age, heart rate, and systolic/diastolic blood pressure. DAS patients were in a higher New York Heart Association (NYHA) functional class than PAS patients. In DAS and PAS patients, LV muscle mass was increased compared with the CON group. LV systolic and diastolic diameters and LV systolic and diastolic volumes were significantly elevated in DAS patients. In those patients, LV
Discussion
In patients with severe AS, signs and symptoms of CHF are associated with increased mortality rates and higher operative risk.2, 4, 14 Thus, careful evaluation of LV function is mandatory in such patients. However, heart failure symptoms may result from diastolic, systolic, or “combined” LV dysfunction. The Tei index, “(ICT + IRT)/ET,” incorporates phases of active LV chamber contraction and relaxation.7, 8, 9, 10 Consequently, in patients with severe AS, this index could be more effective for
Conclusion
In patients with severe AS, the Tei index is easily obtained and highly reproducible. In AS patients in a poor NYHA functional class, who have overall cardiac dysfunction, the index is increased. In AS patients with preserved systolic function, the index is decreased. The index differentiates between AS patients with depressed and preserved systolic LV function, and may thus provide relevant information in the echocardiographic work-up and care of such patients. Further prospective studies have
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Reprint requests: Christian Bruch, MD, Westfälische Wilhelms-Universität Muenster, Innere Medizin C, Albert-Schweitzer-Str. 33, 48149 Muenster, Germany (E-mail: [email protected]).