Usefulness of Tissue Doppler Imaging-Myocardial Performance Index in the Evaluation of Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction

Background: In heart failure with preserved ejection fraction (HFPEF), physiological abnormalities are not solely restricted to diastolic function. Because the tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) offers the advantage of recording systolic and diastolic tissue velocity simultaneously in the same cardiac cycle, this study aimed to determine whether TDI-MPI is an informative index for assessing HFPEF, compared with conventional echo parameters. Hypothesis: In patients with HFPEF, TDI-MPI would be an independent predictor for adverse cardiac events. Methods: Among 408 patients who had diastolic dysfunction without heart failure (HF) or HFPEF, cardiac function was evaluated by mitrat flow (MF) or TDI-MPI. During the median follow-up of 32 months, clinical outcomes, which were defined as the composite of cardiovascular death and admission for HF, were assessed. Results: Mean MF and TDI-MPI were significantly greater in the HFPEF group. TDI-MPI rather than MF had a significant correlation with N-terminal pro-brain natriuretic peptide level. The area under the receiver operating characteristic curve of TDI-MPI for the detection of HFPEF was 0.86. With regard to clinical outcomes, 31 events were identified during follow-up periods. On a multivariate analysis, TDI-MPI > 0.66 was the best prognostic predictor of events and provided incremental predictive value. Conclusions: Compared to MF-MPI, TDI-MPI may be a more useful parameter for the evaluation of patients with HFPEF.