The Tei index: A new prognostic index for patients with symptomatic heart failure

Background: The Tei index (TI) is a new echocardiographic/Doppler index of combined systolic and diastolic function, calculated as isovolumic relaxation time plus isovolumic contraction time divided by ejection time. This purpose of this study was to explore the prognostic value of TI in patients with heart failure from left ventricular (LV) systolic dysfunction. Methods: Of 105 randomly selected participants with LV ejection fraction less than 30% and at least 1 hospitalization for heart failure, we included 60 patients in whom assessment of the TI was technically feasible. Using the patients' medical records, we collected information on several clinical and echocardiographic variables. We monitored patients for a mean duration of 24+/-19 months from the time of the echocardiogram. The study outcome was the composite of death from any cause or emergency heart transplant. Results: The median value (interquartile range) of TI was 0.79 (0.54, 1.14). Of 57 patients (95%) with complete follow-up, 28 (49%) died, and 2 (3.5%) underwent emergency heart transplant at a mean duration of 17+/-14 months. Kaplan-Meier survival curves showed a higher cumulative incidence of the study end point among patients in the highest quartile of TI, compared with the other 3 quartiles (log rank P=.002). After adjustment for potential clinical confounders, TI in the highest quartile (TI>1.14) was a significant independent predictor of the composite end point (odds ratio 5.3, 95% confidence interval 1.9 to 14.9, P=.0018). Conclusion: Prolonged TI (>1.14) is a powerful and independent predictor of poor clinical outcome in patients with symptomatic heart failure and severe LV systolic dysfunction.