Swiss Registry Analyzes Prognostic Relevance of Tei Index for Left Ventricular Myocardial Performance in TAVR

January 22, 2019—Tei, the left ventricular myocardial performance index, is associated with impaired clinical outcomes during short- and longer-term follow-up after transcatheter aortic valve replacement (TAVR), concluded Masahiko Asami, MD, et al in findings from the SWISS TAVI registry published online in Circulation: Cardiovascular Interventions.

The study's background is that Tei is an echocardiographic parameter that incorporates the information of systolic and diastolic time intervals. Whereas the prognostic value of selected systolic and diastolic parameters is well established after TAVR, the role of Tei has not been evaluated in this setting.

Between August 2007 and December 2015, consecutive patients with symptomatic, severe aortic stenosis and transthoracic echocardiography pre- and post-TAVR were considered eligible for this analysis. The primary endpoint was all-cause mortality at 1 year after TAVR.

As reported in Circulation: Cardiovascular Interventions, the investigators found:

• Of 824 patients with echocardiographic images to calculate Tei, pre-Tei was normal (< 0.45) in 639 patients and high (≥ 0.45) in 185 patients, whereas post-Tei was normal in 602 patients and high in 120 patients.
• After adjusting for confounding factors, high pre-Tei was associated with an increased risk of all-cause mortality at 30 days (adjusted hazard ratio [HR], 3.62; 95% confidence interval [CI], 1.89–6.91) and 1 year (adjusted HR, 2.56; 95% CI, 1.78–3.69).
• Post-Tei was associated with an increased risk of mortality between 30 days and 1-year follow-up (adjusted HR, 6.70; 95% CI, 4.22–10.63).
• At multivariable analysis, Tei emerged as an independent predictor of early (pre-Tei index per 0.1–adjusted HR,1.40; 95% CI, 1.23–1.60) and late mortality (post-Tei index per 0.1–adjusted HR, 1.40; 95% CI, 1.31–1.50).