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Modified TEI index: a promising parameter in essential hypertension?
Nurgül Keser1, Sezai Yildiz, Nuri Kurtoğ
1Department of Cardiology, University of Maltepe-Istanbul, Istanbul, Turkey. nesenur@superonline.com
Insights
The modified TEI index effectively assesses global cardiac function in hypertension, showing impaired systolic and diastolic functions even before left ventricular hypertrophy develops. This index is a sensitive tool for monitoring hypertensive patients and guiding interventions.
Area of Science:
- Cardiology
- Echocardiography
- Hypertension Research
Background:
- The modified TEI index is recognized for its efficacy in evaluating global cardiac functions.
- Its specific application and correlation with left ventricular mass index (LVMI) in hypertensive patients require further investigation.
Purpose of the Study:
- To assess the applicability of the modified TEI index in patients with mild to moderate hypertension.
- To determine the relationship between the modified TEI index and left ventricular mass index (LVMI) in hypertensive individuals.
Main Methods:
- Studied 48 hypertensive patients (divided into normal and increased LVMI groups) and 20 healthy controls.
- Utilized 2D, Doppler, and mitral annulus pulse wave tissue Doppler for measurements.
- Calculated the modified TEI index using specific diastolic and systolic time intervals.
Main Results:
- The modified TEI index was significantly higher in hypertensive groups compared to controls (P < 0.0001).
- Group II (increased LVMI) showed a significantly higher modified TEI index than Group I (normal LVMI).
Conclusions:
- The modified TEI index demonstrates impaired left ventricular systolic and diastolic functions in hypertensives, preceding hypertrophy.
- It serves as a safe, feasible, and sensitive indicator for evaluating global ventricular function in hypertension.
- Periodic assessment with the modified TEI index can guide interventions to preserve cardiac function and complements standard Doppler echocardiography.
Purpose:
Modified TEI index is pointed to be more effective in the evaluation of global cardiac functions compared to systolic and diastolic measurements alone. We planned to determine its applicability in hypertension and relation with left ventricular mass index (LVMI).
Methods:
We studied 48 patients with mild/moderate hypertension and normal coronary angiograms. In total 22 patients (12 men, 10 women, mean age: 55 +/- 6) with normal LVMI were studied in group I, 26 patients (12 men, 14 women, mean age: 57 +/- 7) with increased LVMI in group II, and 20 patients (10 men, 10 women, mean age: 53 +/- 7) with normal blood pressure as a control group. Standard 2D, Doppler, and mitral annulus pulse wave tissue Doppler were used for all measurements. Modified TEI index was calculated as diastolic time interval measured from end of Am wave to origin of Em (a') minus systolic Sm duration (b') divided by b(a'-b'/b').
Results:
Modified TEI index was significantly higher in both groups than normal group and in group II than in group I. (
Control Group:
0.33 +/- 0.05, group I: 0.51 +/- 0.17, group II: 0.68 +/- 0.16, P< 0.0001).
Conclusion:
Modified TEI index, a marker of left ventricular systolic and diastolic functions, is impaired in hypertensives before hypertrophy develops and impairment is more prominent in hypertrophy. Therefore, (1) modified TEI index in hypertensives is a safe, feasible, and sensitive index for evaluation of global ventricular functions. (2) Evaluation of hypertensives with this index periodically may guide interventions directed toward saving systolic and diastolic functions. (3) Modified TEI index is gaining importance as a complementary parameter to standard Doppler or in cases where standard Doppler has its limitations.