title: Noninvasive differentiation of pseudonormal/restrictive from normal mitral flow by Tei index: a simultaneous echocardiography-catheterization study in patients with acute anteroseptal myocardial infarction.
abstract: BACKGROUND
  Differentiation of pseudonormal/restrictive from normal mitral flow is still clinically problematic. Pseudonormal/restrictive flow is usually associated with left ventricular dysfunction, which can be detected by Doppler Tei index, combining systolic and diastolic function. Therefore, the purpose of this study was to test the feasibility of the Tei index to differentiate pseudonormal/restrictive from normal mitral flow.
  
  
  METHODS
  In 26 patients with anteroseptal acute myocardial infarction and early diastolic mitral flow velocity (E) to late diastolic mitral flow velocity (A) ratio (E/A) > or = 1, left ventricular volumes; E and A; deceleration time of E; and the Tei index, defined as the sum of the isovolumic contraction and relaxation time divided by ejection time, were evaluated by Doppler echocardiography, and pulmonary capillary wedge pressure was measured by catheterization. Pseudonormal/restrictive mitral flow was defined as E/A > or = 1 associated with pulmonary capillary wedge pressure > 12 mm Hg.
  
  
  RESULTS
  There were 19 and 7 patients with pseudonormal/restrictive and normal mitral flow, respectively. Among the indices of left ventricular function, the Tei index achieved the best correlation with pulmonary capillary wedge pressure (r(2) = 0.66, P <.0001). By setting the Tei index > or = 0.55 as the criteria for pseudonormal/restrictive mitral flow, this diagnosis had the sensitivity, specificity, and accuracy of 84%, 100%, and 88%, respectively.
  
  
  CONCLUSIONS
  The Tei index allows noninvasive differentiation of pseudonormal/restrictive from normal mitral flow.
authors.affiliation: First Department of Internal Medicine, Kagoshima University School of Medicine, Sakuragaoka, Kagoshima, Japan.
authors.forename: AlaaAldin Rabea
authors.initials: AR
authors.lastname: Abd-El-Rahim
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
authors.forename: Toshinori
authors.initials: T
authors.lastname: Yuasa
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Kunitsugu
authors.initials: K
authors.lastname: Takasaki
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kumanohoso
authors.forename: Shiro
authors.initials: S
authors.lastname: Yoshifuku
authors.forename: Eiji
authors.initials: E
authors.lastname: Kuwahara
authors.forename: Kouichi
authors.initials: K
authors.lastname: Toyonaga
authors.forename: Takashi
authors.initials: T
authors.lastname: Murayama
authors.forename: Chihaya
authors.initials: C
authors.lastname: Koriyama
authors.forename: Akira
authors.initials: A
authors.lastname: Kisanuki
authors.forename: Aly
authors.initials: A
authors.lastname: Hegazy
authors.forename: Shinichi
authors.initials: S
authors.lastname: Minagoe
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*