Noninvasive Differentiation of Pseudonormal/Restrictive from Normal Mitral Flow by Tei Index: A Simultaneous Echocardiography-Catheterization Study in Patients with Acute Anteroseptal Myocardial Infarction

Background: Differentiation of pseudonormal/restrictive from normal mitral flow is still clinically problematic. Pseudonormal/restrictive flow is usually associated with left ventricular dysfunction, which can be detected by Doppler Tei index, combining systolic and diastolic function. Therefore, the purpose of this study was to test the feasibility of the Tei index to differentiate pseudonormal/restrictive from normal mitral flow. Methods: In 26 patients with anteroseptal acute myocardial infarction and early diastolic mitral flow velocity (E) to late diastolic mitral flow velocity (A) ratio (E/A) ≥ 1, left ventricular volumes; E and A; deceleration time of E; and the Tei index, defined as the sum of the isovolumic contraction and relaxation time divided by ejection time, were evaluated by Doppler echocardiography, and pulmonary capillary wedge pressure was measured by catheterization. Pseudonormal/restrictive mitral flow was defined as E/A ≥ 1 associated with pulmonary capillary wedge pressure > 12 mm Hg. Results: There were 19 and 7 patients with pseudonormal/restrictive and normal mitral flow, respectively. Among the indices of left ventricular function, the Tei index achieved the best correlation with pulmonary capillary wedge pressure (r2 = 0.66, P < .0001). By setting the Tei index ≥ 0.55 as the criteria for pseudonormal/restrictive mitral flow, this diagnosis had the sensitivity, specificity, and accuracy of 84%, 100%, and 88%, respectively. Conclusion: The Tei index allows noninvasive differentiation of pseudonormal/restrictive from normal mitral flow.