title: Prognostic role of myocardial performance index on long-term survival after heart transplantation: a prospective study.
abstract: The survival rate of heart transplant patients is increasing, underlying the need for accurate predictors of adverse events during clinical follow-up. Myocardial performance index (MPI) is a Doppler-derived index of combined systolic and diastolic function: we assessed the prognostic role of MPI in survival of patients >1 year after heart transplantation (HT). A total of 152 consecutive HT patients referred to our institution were enrolled in this prospective study. Primary endpoints were cardiac death and a composite of major adverse cardiac events (MACE). During follow-up (69 ± 22 months), 68 (44.7%) patients had an adverse event and 20 (13.15%) patients died. Patients with MACE during follow-up showed lower EF (57.3 ± 9.3 vs. 63 ± 6.1; P < 0.001) and higher MPI (0.45 ± 0.19 vs. 0.31 ± 0.13; P < 0.001) at enrolment. MPI and EF were independently related to MACE (OR = 2.2; 95% confidence interval [CI] = 1.01-5.1; and OR = 6.6; 95% CI = 3.5-11.2, respectively) and showed strong diagnostic power (MPI: receiver operating characteristic [ROC] area = 79%, with 79% sensitivity and 81% specificity; EF: ROC area = 77%, with 54% sensitivity and 91% specificity) in the subsequent year. Patients with EF > 50% and MPI < 0.45 at enrolment showed 75% event-free survival 5 years after HT. In HT patients, MPI combined with EF was an accurate means of predicting long-term adverse events.
authors.affiliation: Division of Cardiology, University of Torino, Hospital S. Giovanni Battista, Torino, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Frea
authors.forename: Michele
authors.initials: M
authors.lastname: Capriolo
authors.forename: Laura
authors.initials: L
authors.lastname: Bergamasco
authors.forename: Cristina
authors.initials: C
authors.lastname: Iacovino
authors.forename: Francesca Calì
authors.initials: FC
authors.lastname: Quaglia
authors.forename: Marco
authors.initials: M
authors.lastname: Ribezzo
authors.forename: Walter Grosso
authors.initials: WG
authors.lastname: Marra
authors.forename: Massimo
authors.initials: M
authors.lastname: Boffini
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Mara
authors.initials: M
authors.lastname: Morello
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*
keywords: Tei index; diastolic function; graft failure; tissue Doppler echocardiography