[Evaluation of restenosis after percutaneous transluminal coronary angioplasty using a Doppler index, the Tei index]
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
H Kamishirado1, T Hayashi, H Hatano
1Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama.
Insights
The Tei index, a Doppler measure, improved significantly after percutaneous transluminal coronary angioplasty (PTCA) in patients with old myocardial infarction (OMI) but no restenosis. This index aids in evaluating PTCA outcomes in OMI patients.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for ischemic heart disease.
- Evaluating cardiac function and restenosis after PTCA is crucial for patient outcomes.
- The Tei index, a Doppler-derived measure, assesses global cardiac function.
Purpose of the Study:
- To evaluate cardiac function and restenosis after PTCA using the Tei index.
- To compare the effectiveness of the Tei index in patients with angina versus old myocardial infarction (OMI).
- To determine the utility of the Tei index in predicting restenosis post-PTCA.
Main Methods:
- Thirty-eight patients with ischemic heart disease underwent M-mode echocardiography before and 6 months after PTCA.
- Measurements included ejection fraction, deceleration time, and the Tei index [(isovolumetric contraction time + isovolumetric relaxation time) / ejection time].
- Patients were categorized based on underlying heart disease (angina pectoris or OMI) and presence or absence of restenosis.
Main Results:
- In patients with angina pectoris, PTCA did not significantly alter ejection fraction, deceleration time, or Tei index, regardless of restenosis.
- In OMI patients with restenosis, the Tei index showed a slight, non-significant increase post-PTCA.
- Crucially, in OMI patients without restenosis, the Tei index significantly improved after PTCA (p < 0.05).
Conclusions:
- The Tei index significantly improved in patients with left ventricular asynergy due to OMI, specifically in those without restenosis post-PTCA.
- The Tei index is a valuable tool for evaluating restenosis after PTCA in patients with old myocardial infarction.
- The findings suggest the Tei index can differentiate between successful and unsuccessful PTCA outcomes in OMI patients.
Abstract:
Cardiac function and restenosis were evaluated after percutaneous transluminal coronary angioplasty (PTCA) using a Doppler index (the Tei index). Thirty-eight patients, 31 men and 7 women (mean age 57 years) with ischemic heart disease were studied. The underlying heart diseases were angina pectoris without left ventricular asynergy in 16 patients and old myocardial infarction (OMI) with left ventricular asynergy in 22 . Ejection fraction was measured by M-mode echocardiography and deceleration time, and the interval between cessation and onset of the mitral inflow velocity (a), ejection time at aortic valve (b), and the Tei index [(a-b)/b] were measured by M-mode echocardiography performed before and 6 months after PTCA. The ejection fraction, deceleration time and Tei index showed no changes after PTCA in patients with angina pectoris with or without restenosis. In patients with OMI with restenosis, the Tei index increased slightly after PTCA, from 0.56 +/- 0.15 to 0.61 +/- 0.13. The deceleration time changed from 0.23 +/- 0.03 to 0.24 +/- 0.02 msec, and the ejection fraction from 0.46 +/- 0.11 to 0.51 +/- 0.17, neither significantly. However, in patients with OMI without restenosis (15 out of 22 patients), the Tei index significantly improved after PTCA, from 0.55 +/- 0.13 to 0.48 +/- 0.12 (p < 0.05). In patients with left ventricular asynergy due to old myocardial infarction, without restenosis, the Tei index significantly improved after PTCA. The Tei index is useful for evaluating restenosis after PTCA in patients with OMI.
