Modified TEI Index: A Promising Parameter in Essential Hypertension? Nurg ¨ ul Keser, M.D., Sezai Yildiz, M.D., Nuri Kurto˘ glu, M.D., and Ismet Dindar, M.D. Department of Cardiology, University of Maltepe-Istanbul, Istanbul, Turkey Purpose: Modified TEI index is pointed to be more effective in the evaluation of global cardiac functions compared to systolic and diastolic measurements alone. We planned to determine its applicability in hypertension and relation with left ventricular mass index (LVMI). Methods: We studied 48 patients with mild/moderate hypertension and normal coronary angiograms. In total 22 patients (12 men, 10 women, mean age: 55 ± 6) with normal LVMI were studied in group I, 26 patients (12 men, 14 women, mean age: 57 ± 7) with increased LVMI in group II, and 20 patients (10 men, 10 women, mean age: 53 ± 7) with normal blood pressure as a control group. Standard 2D, Doppler, and mitral annulus pulse wave tissue Doppler were used for all measurements. Modified TEI index was calculated as diastolic time interval measured from end of Am wave to origin of Em (a ′ ) minus systolic Sm duration (b ′ ) divided by b(a ′ −b ′ /b ′ ). Results: Modified TEI index was significantly higher in both groups than normal group and in group II than in group I. (Control group: 0.33 ± 0.05, group I: 0.51 ± 0.17, group II: 0.68 ± 0.16, P< 0.0001). Conclusion: Modified TEI index, a marker of left ventricular systolic and diastolic functions, is impaired in hypertensives before hypertrophy develops and impairment is more prominent in hypertrophy. Therefore, (1) modified TEI index in hypertensives is a safe, feasible, and sensitive index for evaluation of global ventricular functions. (2) Evaluation of hypertensives with this index periodically may guide interventions directed toward saving systolic and diastolic functions. (3) Modified TEI index is gaining importance as a complementary parameter to standard Doppler or in cases where standard Doppler has its limitations. (ECHOCARDIOGRAPHY, Volume 22, April 2005) tissue Doppler, hypertension, TEI index Essential hypertension is a complex pathol- ogy that resembles an iceberg causing vari- ous end organ damages before overt symptoms or acute catastrophic events develop. Among these end organ damages, left ventricular hy- pertrophy (LVH) is a common phenomenon and can be recorded in the very early stages of hy- pertension. 1−3 However before LVH develops, hypertension may still damage the heart by causing fibrotic changes in the left ventricular (LV) subendocardium resulting in LV diastolic dysfunction, 2−4 which has been recognized as an important primary cause of heart failure. 5 Aside from an increase in afterload, the primary abnormality in essential hypertension may be This article has been accepted as a poster presentation in ESC 2003-Vienna. Address for correspondence and reprint requests: Nurg ¨ ul Keser, M.D., Erdo ˘ gdu sok Manolya apt. 5/7 Fenery- olu, Istanbul, Turkey. Fax: +902163709719; E-mail: nesenur@superonline.com impaired myocardial function which provides the impetus for the development of compen- satory LVH. Therefore, it is of utmost impor- tance to find an independent predictor that will unmask LV dysfunction in hypertension. This index may be useful for determining treatment strategy and evaluating treatment effects on the regression of the ongoing pathologic process before overt symptoms develop. Measurements of transmitral blood flow ve- locities provided qualitative description of di- astolic dysfunction in hypertension and in LVH but these parameters are affected by sev- eral factors including volume status, left atrial (LA) pressure, age, and rate of myocardial re- laxation. 6,7 Besides diastolic function, systolic function might have also started deteriorating before being detected by LVEF. A quantitative and easily measured Doppler index of combined systolic and diastolic ventric- ular myocardial performance (TEI index) was recently proposed as a potentially useful pre- dictor of global myocardial performance. 8,9 One 296 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. Vol. 22, No. 4, 2005