Significance of Tei-index alterations induced by acute preload reduction with hemodialysis

The load dependence of Tei-index, an index to estimate combined systolic and diastolic ventricular functions, remains controversial. Moreover, its significance in the setting of acute preload reduction including hemodialysis (HD) remains unknown. Therefore, we examined the significance of the Tei-index in HD patients.

Doppler echocardiographic parameters of 42 patients with normal left ventricular ejection fraction (LVEF) were evaluated before and after HD. Based on the index of body water excess calculated using a Crit-Line monitor, the patients were assigned to Group A (normal hydration approximately overhydration) and Group B (risk of pulmonary congestion).

Group A was younger and had a shorter isovolumic relaxation time (IRT) than Group B before HD. Hemodialysis significantly increased the Tei-index of Group A, which was derived from prolonging IRT and isovolumic contraction time and shortening the ejection time without changing LVEF. Changes in the Tei-index (DeltaTei-index) significantly correlated with the rate at which blood volume decreased. They were derived from graphs generated using the Crit-Line monitor. Furthermore, the DeltaTei-index inversely correlated with the Tei-index before HD.

These findings suggest that the Tei-index is preload-dependent, which is related to changes in volume and speed. Thus, the Tei-index should be cautiously interpreted according to various hemodynamic situations. However, the correlation between the DeltaTei-index and the Tei-index before HD implies that the latter could be a good indicator of effective fluid removal by HD.