title: The Myocardial Performance Index detects chronic cardiac allograft dysfunction sooner than other methods.
abstract: OBJECTIVE
  Many noninvasive techniques have been proposed for the early detection of chronic heart graft dysfunction. Diastolic dysfunction may precede systolic dysfunction, and often is prominent; therefore, the aim of the study was to investigate the clinical and prognostic value of a Doppler-derived index of both systolic and diastolic function in heart transplanted patients (Myocardial Performance Index, MPI).
  
  
  METHODS
  The MPI was measured in 63 consecutive patients (mean age 55 years, 49 men and 14 women) in sinus rhythm with an orthotopic heart transplantation for at least 1 year (mean 5.3 years) and in 63 age and sex-matched controls. A complete clinical examination was performed at the time of enrollment and was repeated after 3 months.
  
  
  RESULTS
  At 3 months, 11 patients (17.5%) presented events (heart failure, hospitalisation or cardiac death). Patients were divided into 2 groups: Group A (52 patients) without events in the follow-up and Group B (11 patients) with events. The values of MPI in Group B (0.55+/-0.19) were significantly higher than values in Group A (0.34+/-0.18, P=0.001). Whereas the values of the index did not differ significantly between Group A and control group (0.34+/-0.18 vs 0.33+/-0.10, P=NS). In the univariate analysis, the population of heart transplanted patients was dichotomised in subgroups by a cut-off MPI of 0.47 and a cut-off ejection fraction (EF) of 50%. Nine patients (41%) with MPI=or>0.47 presented events, while only 2 patients (5%) with MPI<0.47 had any event (P<0.001; c2 12.9). Six patients (85%) with EF<50% had events, while only 5 patients (9%) with EF=or>50% had an event (P<0.001; c2 14). In the multivariate analysis only MPI (chi squared=22.6, P=0.018) and EF (chi squared=20.8, P=0.025) were significant independent predictors of heart failure or cardiac death. By looking at Kaplan-Meyer curves, MPI seems to be better than EF in the earlier detection of graft dysfunction.
  
  
  CONCLUSIONS
  MPI, as a combined systolic and diastolic index, may detect graft dysfunction earlier than EF.
authors.affiliation: Division of Cardiology and Internal Medicine, San Giovanni Battista Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Frea
authors.forename: M
authors.initials: M
authors.lastname: Morello
authors.forename: M
authors.initials: M
authors.lastname: Bobbio
authors.forename: R
authors.initials: R
authors.lastname: Saviolo
authors.forename: L
authors.initials: L
authors.lastname: Mangiardi
authors.forename: G P
authors.initials: GP
authors.lastname: Trevi
mesh_terms: D002908:Chronic Disease; D051799:Delayed Graft Function / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors