title: Usefulness of tissue Doppler imaging-myocardial performance index in the evaluation of diastolic dysfunction and heart failure with preserved ejection fraction.
abstract: 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.
  
  
  OBJECTIVE
  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 mitral 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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea. khyungseop@dsmc.or.kr
authors.forename: Hyungseop
authors.initials: H
authors.lastname: Kim
authors.forename: Hyuck-Jun
authors.initials: HJ
authors.lastname: Yoon
authors.forename: Hyoung-Seob
authors.initials: HS
authors.lastname: Park
authors.forename: Yun-Kyeong
authors.initials: YK
authors.lastname: Cho
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Yoon-Nyun
authors.initials: YN
authors.lastname: Kim
authors.forename: Kwon-Bae
authors.initials: KB
authors.lastname: Kim
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D005260:Female; D054144:Heart Failure, Diastolic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D009200:Myocardial Contraction; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain