Abstract 3743: Elevated Right-sided Tei Index Signifies Poorer Prognosis and Worsening Left Ventricular Diastolic Dysfunction in Chronic Heart Failure: An ADEPT Ancillary Study
Background: The right-sided Tei index (RTI) has been demonstrated as a simple, non-invasive estimate of right ventricular (RV) function. The relation between RTI and left ventricular (LV) diastolic dysfunction and it’s prognostic role in patients with CHF is unknown.
Methods: We evaluated 143 CHF patients (LVEF<35%, NYHA II-IV) enrolled in the ADEPT study. RTI was determined by echocardiography as the ratio of RV isovolumetric time to the RV outflow tract ejection time. LV diastolic stage was classified as impaired relaxation, pseudonormal and restrictive filling patterns. Long-term assessment of mortality or cardiac transplantation was followed for 34 ± 17 months by chart review and telephone.
Results: In our study cohort (mean age 59 ±13 years, mean LVEF 25 ±6%, mean RTI 0.85 ±0.34) increasing RTI correlated to worsening of LV diastolic stage (Spearman’s r=0.31), pulmonary vein S velocity (r=−0.49), and mitral deceleration time (r=−0.37, p<0.001 for all). Patients with the highest tertile of RTI experienced higher rates for death or transplantation compared to those in the 2nd (40% versus 21% p=0.002), or 1st tertile (40% versus 13% p<0.0001). Increasing tertiles of RTI predicted greater risk of adverse events (risk ratio: 1.59, 95% CI: 1.02 − 2.58 p=0.04) after adjusting for diastolic stage, and conferred poorer long term survival. (Figure⇓).
Conclusion: Right-sided Tei index was associated with measures of LV diastolic dysfunction, and may be linked to high LA pressures and reduced LV compliance, characteristic of patients with more restrictive filling patterns. Elevated RTI is indicative of worsening prognosis in CHF patients, independent of diastolic stage.