title: Myocardial Performance Index Determined by Tissue Doppler Imaging in Patients With Systolic Heart Failure Predicts Poor Long-Term Prognosis: An Observational Cohort Study.
abstract: BACKGROUND
  Myocardial performance index (MPI) is an echocardiographic parameter that reflects left ventricular (LV) function. MPI determined by means of tissue Doppler imaging (TDI) at different LV sites (global MPI) and its long-term prognostic implications in congestive heart failure (HF) have not been evaluated.
  
  
  RESULTS
  A total of 110 patients with HF during acute hospitalization were followed for a mean of 5.0 years for survivors. The myocardial velocities at 4 different LV sites near the mitral annulus from apical views were recorded with the use of pulsed-wave TDI. From myocardial velocity profiles, the MPI at each LV site was calculated: MPI = (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. The global MPI was calculated as the mean from the 4 LV sites. Mean ejection fraction was 25%. A total of 61 patients died during the study period. On multivariate analysis, only MPI emerged as an independent predictor of mortality. With a cutoff value of 0.67, the hazard ratio for cardiovascular mortality during the follow-up period was 13 (95% confidence interval 5.03-34.44; P < .001). A cutoff MPI value of ≥0.67 identified patient mortality during the study period with a sensitivity of 86% and a specificity of 79%.
  
  
  CONCLUSIONS
  Global TDI-derived MPI in patients with HF is a powerful predictor of cardiovascular mortality in patients with systolic HF.
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. Electronic address: jens.olsson@sodersjukhuset.se.
authors.forename: Jens M
authors.initials: JM
authors.lastname: Olson
authors.affiliation: Department of Clinical Science, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bassem A
authors.initials: BA
authors.lastname: Samad
authors.affiliation: Department of Clinical Science, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mahbubul
authors.initials: M
authors.lastname: Alam
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Myocardial performance index; congestive heart failure; prognosis