Abstract
Introduction
LV dysfunction develops early in hypertension, even previously to left ventricular remodeling.
Aims
To determine the frequency of morphologic and functional heart abnormalities associated to abnormal modified Tei Index in untreated hypertensive (HBP) patients (p) with preserved ejection fraction (pEF).
Methods
Case–control study. Three groups: (1) HBP without left ventricular hypertrophy (LVH); (2) HBP with LVH; (3) non-HBP controls. Ejection fraction >54 % identified pEF. LVH measured by Devereux method. Systolic and diastolic functions assessed by standard echocardiography and tissue Doppler. 2013 ESH/ESC Hypertension Guidelines normal values were considered. Tei index measured at the lateral and septal LV walls in apical 4-chamber view by tissue Doppler, value >0.40 considered abnormal. Statistical analysis: multifactorial ANOVA test adjusted by sex and age, p < 0.05 statistically significant.
Results
The study included 14 controls, 88 HBP p without LVH, and 19 HBP p with LVH. The HBP p sample mean age was 58.7 ± 13.5 years and 52 (44.1 %) were males. Mean Tei Index was 0.35 ± 0.03 in controls; 0.42 ± 0.05 in HBP without LVH; and 0.42 ± 0.06 in HBP with LVH (p < 0.025). Abnormal Tei Index was present in 2p (14.3 %) controls; 64 p (72.7 %) HBP without LVH; and 15 p (78.9 %) HBP with LVH (p < 0.0009). Tissue Doppler’s wave was 8.4 ± 0.9 cm/s in controls; 8 ± 1.6 cm/s in HBP without LVH and 7.8 ± 1.1 cm/s in HBP with LVH.
Conclusions
(1) Left ventricular dysfunction is frequent in HBP p, even without LVH; (2) modified tissue Doppler Tei index is a useful tool for the diagnosis of left ventricular dysfunction.
Similar content being viewed by others
References
Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, Tu JV, Levy D. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction. Insights from the Framingham Heart Study of the National Heart, Lung, and Blood Institute. Circulation. 2009;119:3070–7.
Piskorz D, Citta L, Citta N, Citta P, Keller L, Bongarzoni L, Mata L, Tommasi A. Association of systolic dysfunction with left ventricular hypertrophy and diastolic dysfunction in hypertensive patients. Rev Fac Cien Med Univ Nac Cordoba. 2014;71:158–64.
Müller-Brunotte R, Kahan T, Malmqvist K, Ring M, Edner M. Tissue velocity echocardiography shows early improvement in diastolic function with irbesartan and atenolol therapy in patients with hypertensive left ventricular hypertrophy. Results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs Atenolol (SILVHIA). Am J Hypertens. 2006;19:927–36.
Ceyhan C, Unal S, Yenisey C, Tekten T, Ceyhan FB. The role of N terminal pro-brain natriuretic peptide in the evaluation of left ventricular diastolic dysfunction: correlation with echocardiographic indexes in hypertensive patients. Int J Cardiovasc Imaging. 2008;24:153–259.
Kane J, Karon BL, Mahoney DW, Redfield MM, Roger VL, Burnett JC Jr, Jacobsen SJ, Rodehefler RJ. Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA. 2011;306:856–63.
Bella JN, Palmieri V, Liu JE, Kitzman DW, Oberman A, Hunt SC, Hopkins PN, Rao DC, Arnett DK, Devereux RB, Hypertension Genetic Epidemiology Network Study Group. Relationship between left ventricular diastolic relaxation and systolic function in hypertension: the Hypertension Genetic Epidemiology Network (HyperGEN) Study. Hypertension. 2001;38:424–8.
Galderisi M, Esposito R, Schiano-Lomoriello V, Santoro A, Ippolito R, Schiattarella P, Strazullo O, de Simone G. Correlates of global area strain in native hypertensive patients: a three-dimensional speckle-tracking echocardiography study. Eur Heart J Cardiovasc Imag. 2012;13:730–8.
Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurement. J Am Soc Echocardiogr. 1997;10:169–78.
Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Task Force Members. 2013 ESH/ESC guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.
Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Bilo G, Clement D, de la Sierra A, de Leeuw P, Dolan E, Fagard R, Graves J, Head GA, Imai Y, Kario K, Lurbe E, Mallion JM, Mancia G, Mengden T, Myers M, Ogedegbe G, Ohkubo T, Omboni S, Palatini P, Redon J, Ruilope LM, Shennan A, Staessen JA, vanMontfrans G, Verdecchia P, Waeber B, Wang J, Zanchetti A, Zhang Y. European society of hypertension working group on blood pressure monitoring and cardiovascular variability. J Hypertens. 2014;32:1359–66.
Piskorz D, Tommasi A. La disfunción diastólica en pacientes hipertensos no es debida a hipertrofia ventricular izquierda. Ins Card. 2011;6:2–7.
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.
Devereux RB, Pini R, Aurigemma GP, Roman MJ. Measurement of left ventricular mass: methodology and expertise. J Hypertens. 1997;15:801–9.
Lang RM, Biering M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–33.
Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol. 1995;26:396–404.
Galiuto L, Ignone G, DeMaria A. Contraction and relaxation velocities of the normal left ventricle using pulsed-wave tissue Doppler echocardiography. Am J Cardiol. 1998;81:609–14.
Keser N, Yildiz S, Kurtoğ N, Dindar I. Modified TEI index: a promising parameter in essential hypertension? Echocardiography. 2005;22:296–304.
Kaypakli O, Gur M, Gozukara MY, Ucar H, Kivrak A, Şeker T, Şahin DY, Elbasan Z, Türkoğlu C, Çayli M. Association between high-sensitivity troponin T, left ventricular hypertrophy, and myocardial performance index. Herz. 2015;40:1004–10.
Takasaki K, Miyata M, Imamura M, Yuasa T, Kuwahara E, Kubota K, Kono M, Ueya N, Horizoe Y, Chaen H, Mizukami N, Kisanuki A, Hamasaki S, Tei C. Left ventricular dysfunction assessed by cardiac time interval analysis among different geometric patterns in untreated hypertension. Circ J. 2012;76:1409–14.
Zwain AA, Noaman AH, Al Esawi RW, Ponoth P. Myocardial performance index (MPI) is not influenced by increased left ventricular mass in healthy obese men. Cardiovasc Revasc Med. 2013;14:18–22.
De Simone G, Izzo R, Chinali M, De Marco M, Casalnuovo G, Rozza F, Girfoglio D, Iovino GL, Trimarco B, De Luca N. Does information on systolic and diastolic function improve prediction of a cardiovascular event by left ventricular hypertrophy in arterial hypertension? Hypertension. 2010;56:99–104.
Mogelbang R, Sogaard P, Pedersen SA, Olsen NT, Marott JL, Schnohr P, Goetze JP, Jensen JS. Cardiac dysfunction assessed by echocardiographic tissue Doppler imaging is an independent predictor of mortality in the general population. Circulation. 2009;119:2679–85.
Sharp AS, Tapp RJ, Thom SA, Francis DP, Hughes AD, Stanton AV, Zambanini A, O’Brien E, Chaturvedi N, Lyons S, Byrd S, Poulter NR, Sever PS, Mayet J, ASCOT Investigators. Tissue Doppler E/E′ ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT sub-study. Eur Heart J. 2010;31:747–52.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was not presented previously as a whole or a part anywhere.
This study and its authors do not have sources of support, grants, equipment, drugs, or any combination of these.
The authors disclose funding received for this work from any organization.
The authors disclose any potential conflicts of interest or financial interests relevant to the research.
This study did not involve animals.
This study has been carried out in accordance with the Code of Ethics of the World Medical Association for experiments involving humans and the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Tissera, G., Piskorz, D., Citta, L. et al. Morphologic and Functional Heart Abnormalities Associated to High Modified Tei Index in Hypertensive Patients. High Blood Press Cardiovasc Prev 23, 373–380 (2016). https://doi.org/10.1007/s40292-016-0167-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40292-016-0167-y