Tei index and neurohormonal activation in patients with incident heart failure:: Serial changes and prognostic value

Background: Natriuretic peptides and Tei index are useful indices for risk stratification in advanced left ventricular dysfunction (LVD). Their role in early stages is less clear. Aims: In relation to first diagnosis of LVD to assess the relation of plasma B-type-natriuretic peptide (NT-proBNP) with Tei index, assess serial changes in indices, and to assess the value of indices to predict functional status. Methods: Doppler echocardiography and neurohormonal analysis were performed (n = 150). NYHA class was registered. Results: Tei index correlated with p-NT-proBNP (r=0.75, p < 0.0001), and changes in indices correlated (r=0.36, p=0.001) in LVD (n=80). No functional improvement (n=47) was related to a median increase in Tei index (-0.2, -0.16; 0.09); an improvement (n=31)to a reduction (0.06; -0.19; 0.35), p = 0.02. In the group with functional improvement, more patients had >= 30% reduction in p-NT-proBNP (75% vs. 45%, p < 0.01). Addition of NT-proBNP or Tei index to a clinical model, of no functional improvement, improved log-likelihood chi(2) from 9.32 to 20.18 (p=0.001) and 20.67 (p=0.001). Conclusion: Tei index and p-NT-proBNP demonstrated a fair correlation. Unimproved NYHA class was related to progressive LVD and might be identified by monitoring Tei index or p-NT-proBNP. Advanced LVD and high pre-treatment p-NT-proBNP levels indicated a potential of improvement in functional status. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.