Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-16T03:29:19.905Z Has data issue: false hasContentIssue false
  • English
  • Français

The ‘TEI-index’ is preload dependent and can be measured by transoesophageal echocardiography during mechanical ventilation

Published online by Cambridge University Press:  11 July 2005

J. T. Lutz ,
R. Giebler  and
J. Peters
J. T. Lutz
Affiliation:
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
R. Giebler
Affiliation:
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
J. Peters
Affiliation:
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
Get access

Abstract

Summary

Background and objective: The Doppler-derived echocardiographic TEI-index, defined as the sum of the left ventricular isovolumic contraction and isovolumic relaxation times divided by ejection time, quantifies combined systolic and diastolic ventricular functions. The index has been proposed to be independent of arterial pressure and heart rate, implying a broad clinical usefulness. However, it is unclear whether the index is preload independent. We assessed whether and to what degree the TEI-index is altered by left ventricular loading conditions, and the feasibility of measurement by transoesophageal echocardiography during anaesthesia and mechanical ventilation.

Methods: We studied 17 anaesthetized mechanically ventilated patients with coronary artery disease during variations in left ventricular preload evoked by head-up and head-down tilt, respectively.

Results: A head-down tilt increasing left ventricular end-diastolic area from 18.8 ± 4 to 23.7 ± 4 cm2 (P < 0.05) significantly decreased the TEI-index from 0.5 ± 0.17 to 0.33 ± 0.15 (P < 0.05). In contrast, the TEI-index remained unchanged with decreased left ventricular preload (14.4 ± 3.7 cm2) during head-up tilt.

Conclusions: An increase in preload decreases the TEI-index indicating its sensitivity to acute increases in left ventricular preload. The TEI-index can be measured perioperatively by transoesophageal echocardiography.

Keywords

ECHOCARDIOGRAPHY, TRANSOESOPHAGEALVENTRICULAR FUNCTION, LEFTMYOCARDIAL CONTRACTION, diastole, systole
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 11 , November 2003 , pp. 872 - 877
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358–367.Google Scholar
Quinones MA, Waggoner AD, Reduto LA, et al. A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation 1981; 64: 744–753.Google Scholar
Grossman W. Diastolic dysfunction in congestive heart failure. N Engl J Med 1991; 325: 1557–1564.Google Scholar
Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function – a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357–366.Google Scholar
Tei C, Dujardin KS, Hodge DO, Kyle RA, Tajik AJ, Seward JB. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol 1996; 28: 658–664.Google Scholar
Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997; 10: 169–178.Google Scholar
Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26: 135–136.Google Scholar
Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996; 9: 838–847.Google Scholar
Shanewise JS, Cheung AT, Aronson S, et al. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. J Am Soc Echocardiogr 1999; 12: 884–900.Google Scholar
Descorps-Declere A, Smail N, Vigue B, et al. Transgastric, pulsed Doppler echocardiographic determination of cardiac output. Inten Care Med 1996; 22: 34–38.Google Scholar
Eidem BW, Tei C, O'Leary PW, Cetta F, Seward JB. Nongeometric quantitative assessment of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly. J Am Soc Echocardiogr 1998; 11: 849–856.Google Scholar
Mancini GB, Costello D, Bhargava V, Lew W, LeWinter M, Karliner JS. The isovolumic index: a new noninvasive approach to the assessment of left ventricular function in man. Am J Cardiol 1982; 50: 1401–1408.Google Scholar
Triulzi MO, Castini D, Ornaghi M, Vitolo E. Effects of preload reduction on mitral flow velocity pattern in normal subjects. Am J Cardiol 1990; 66: 995–1001.Google Scholar
Regolisti G, Coghi P, Orlandini G, et al. Effects of reduced preload on diastolic filling in essential hypertensive patients with increased left ventricular mass. Am J Hypertens 1997; 10: 447–453.Google Scholar
Aranda JrJM, Weston MW, Puleo JA, Fontanet HL. Effect of loading conditions on myocardial relaxation velocities determined by Doppler tissue imaging in heart transplant recipients. J Heart Lung Trans 1998; 17: 693–697.Google Scholar
Gaasch WH, Carroll JD, Blaustein AS, Bing OH. Myocardial relaxation: effects of preload on the time course of isovolumetric relaxation. Circulation 1986; 73: 1037–1041.Google Scholar
Quinones MA, Gaasch WH, Alexander JK. Influence of acute changes in preload, afterload, contractile state and heart rate on ejection and isovolumic indices of myocardial contractility in man. Circulation 1976: 53: 293–302.Google Scholar
Yo Y, Nagano M, Nagano N, et al. Effects of age and hypertension on autonomic nervous regulation during passive head-up tilt. Hypertension 1994; 23 (Suppl 1): I 82–I 86.Google Scholar
Bloomfield DM, Kaufman ES, Bigger JrJT, Fleiss J, Rolnitzky L, Steinman R. Passive head-up tilt and actively standing up produce similar overall changes in autonomic balance. Am Heart J 1997; 134: 316–320.Google Scholar
Darmon PL, Hillel Z, Mogtader A, Mindich B, Thys D. Cardiac output by transesophageal echocardiography using continuous-wave Doppler across the aortic valve. Anesthesiology 1994; 80: 796–805.Google Scholar