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Published on: October 14, 2016
The Assessment and Potential Implications of the Myocardial Performance Index Post Exercise in an at Risk Population
Michael Ruisi1, Michael Levine1, Dennis Finkielstein1
1Thomas Killip Division of Cardiology Beth Israel Medical Center, New York, NY, USA.
Insights
The myocardial performance index (MPI) may detect hidden coronary artery disease during exercise stress tests. This echocardiographic measure shows promise for identifying cardiac issues in at-risk individuals.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Function Assessment
Background:
- The myocardial performance index (MPI), developed by Chuwa Tei in 1995, is an echocardiographic measure of overall cardiac function.
- Previous research indicates MPI reflects both left ventricular systolic and diastolic function, offering prognostic value in coronary artery disease (CAD) and heart failure patients.
Purpose of the Study:
- To evaluate the utility of MPI during exercise stress testing for detecting occult coronary artery disease in an at-risk population.
- To assess the prevalence of abnormal resting and stress MPI values in patients with CAD or CAD risk factors.
Main Methods:
- Ninety patients with established CAD or risk factors underwent treadmill exercise stress testing with two-dimensional Doppler echocardiography (Bruce protocol).
- Resting and stress MPI values were measured for all participants.
Main Results:
- An abnormal resting MPI (≤ 0.47) was found in 80% (72/90) of subjects, and an abnormal stress MPI in 53.33% (48/90).
- Average resting MPI was 0.636 (SD 0.182), and average stress MPI was 0.530 (SD 0.250).
- The difference between resting and stress MPI was statistically significant (P < 0.05).
Conclusions:
- Exercise-assessed MPI may serve as a sensitive indicator of occult coronary disease in at-risk individuals.
- This assessment appears independent of traditional wall motion analysis.
Background:
The myocardial performance index (MPI) first described by Chuwa Tei in 1995 is a relatively new echocardiographic variable used for assessment of overall cardiac function. Previous studies have demonstrated the MPI to be a sum representation of both left ventricular systolic and diastolic function with prognostic value in patients with coronary artery disease as well as symptomatic heart failure.
Methods:
Ninety patients with either established coronary artery disease (CAD) or CAD risk factors underwent routine treadmill exercise stress testing with two-dimensional Doppler echocardiography using the standard Bruce protocol. Both resting and stress MPI values were measured for all 90 of the patients.
Results:
Using a normal MPI cut off of ≤ 0.47, the prevalence of an abnormal resting MPI in our 90 subjects was 72/90 or 80% and the prevalence of an abnormal stress MPI in our 90 subjects was 48/90 or 53.33%. The average MPI observed in the resting portion of the stress test for the cohort was: 0.636 with a standard deviation of 0.182. The average MPI in the stress portion of the stress test for the cohort was 0.530 with a standard deviation of 0.250. The P value with the use of a one-tailed dependent T test was calculated to be < 0.05.
Conclusion:
We postulate that these findings reflect that the MPI (Tei) index assessed during exercise may be a sensitive indicator of occult coronary disease in an at risk group independent of wall motion assessment.
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