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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2006 August;47(4):461-7
The Myocardial Performance Index detects chronic cardiac allograft dysfunction sooner than other methods
Frea S., Morello M., Bobbio M., Saviolo R., Mangiardi L., Trevi G. P.
Division of Cardiology and Internal Medicine San Giovanni Battista Hospital University of Turin Medical School, Turin, Italy
Aim. Many noninvasive techniques have been proposed for the early detection of chronic heart graft dysfunction. Diastolic dysfunction may precede systolic dysfunction, and often is prominent; therefore, the aim of the study was to investigate the clinical and prognostic value of a Doppler-derived index of both systolic and diastolic function in heart transplanted patients (Myocardial Performance Index, MPI).
Methods. The MPI was measured in 63 consecutive patients (mean age 55 years, 49 men and 14 women) in sinus rhythm with an orthotopic heart transplantation for at least 1 year (mean 5.3 years) and in 63 age and sex-matched controls. A complete clinical examination was performed at the time of enrolment and was repeated after 3 months.
Results. At 3 months, 11 patients (17.5%) presented events (heart failure, hospitalisation or cardiac death). Patients were divided into 2 groups: Group A (52 patients) without events in the follow-up and Group B (11 patients) with events. The values of MPI in Group B (0.55±0.19) were significantly higher than values in Group A (0.34 ±0.18, P=0.001). Whereas the values of the index did not differ significantly between Group A and control group (0.34±0.18 vs 0.33±0.10, P=NS). In the univariate analysis, the population of heart transplanted patients was dichotomised in subgroups by a cut-off MPI of 0.47 and a cut-off ejection fraction (EF) of 50%. Nine patients (41%) with MPI ≥0.47 presented events, while only 2 patients (5%) with MPI<0.47 had any event (P<0.001; c2 12.9). Six patients (85%) with EF<50% had events, while only 5 patients (9%) with EF ≥50% had an event (P<0.001; c2 14). In the multivariate analysis only MPI (c2=22.6, P=0.018) and EF (c2=20.8, P=0.025) were significant independent predictors of heart failure or cardiac death. By looking at Kaplan-Meyer curves, MPI seems to be better than EF in the earlier detection of graft dysfunction.
Conclusion. MPI, as a combined systolic and diastolic index, may detect graft dysfunction earlier than EF.