Document Detail

Utility of the myocardial performance index in a population with high prevalences of obesity, diabetes, and hypertension: the strong heart study.
MedLine Citation:
PMID:  17381641     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The myocardial performance index (MPI) introduced by Tei, a Doppler-derived echocardiographic measure that reflects both left ventricular (LV) systolic and diastolic function, has been shown to have prognostic value in several clinical settings, including myocardial infarction and congestive heart failure. There are scant data on the correlates and prognostic value of MPI in a population without overt cardiovascular (CV) disease. METHODS: We investigated clinical and physiologic correlates of MPI, as assessed from echocardiographic Doppler recordings in 1,862 American Indian participants free of coronary or valvular disease or LV systolic dysfunction in the population-based strong heart study (SHS). We then assessed the prognostic value of MPI for incident CV events, including nonfatal stroke, coronary heart disease, congestive heart failure, and CV death. RESULTS: The study population was 59 +/- 8 years old (66% women); 48% had diabetes, 44% hypertension, and 54% were obese. In univariable analyses, MPI (mean = 0.24 +/- 0.17) showed significant negative associations with creatinine clearance, C-reactive protein (CRP), LV ejection fraction (EF), mitral valve E- and A-wave velocities, cardiac index (CI), stroke index (SI) and stroke index/pulse pressure (SI/PP), and significant positive associations with serum creatinine and total peripheral resistance index (TPRI) (all P < 0.05). There were no significant associations of MPI with hypertension or diabetes status, systolic or diastolic blood pressure, body mass index, hemoglobin A1C or LV mass. After adjusting for age, sex, diabetes, and hypertension, MPI remained weakly but significantly correlated with CRP, EF, CI, SI, SI/PP, mitral E- and A-wave velocities, and TPRI. MPI did not predict fatal and nonfatal CV events (risk ratio 1.06 per unit MPI, 95% C.I. 0.56-2.04; P = 0.85) at a mean follow-up of 7.1 +/- 2.2 years. CONCLUSIONS: In a population-based sample of adults with high prevalence of diabetes, hypertension, and obesity but without overt CV disease, MPI has weak associations with clinical and physiologic determinants of cardiac function. Moreover, MPI does not provide prognostic information for CV events in this population. Though conceptually attractive as a global measure of cardiac function, MPI has limited utility in a high-risk population without clinical CV disease.
Rakesh K Mishra; Jorge R Kizer; Vittorio Palmieri; Mary J Roman; James M Galloway; Richard R Fabsitz; Elisa T Lee; Lyle G Best; Richard B Devereux
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  24     ISSN:  0742-2822     ISO Abbreviation:  Echocardiography     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-08-24     Revised Date:  2010-04-29    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  United States    
Other Details:
Languages:  eng     Pagination:  340-7     Citation Subset:  IM    
Weill Medical College of Cornell University, New York, New York, USA.
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MeSH Terms
Analysis of Variance
Biological Markers / blood
Blood Flow Velocity
Blood Pressure
Cardiovascular Diseases / epidemiology,  etiology,  physiopathology
Diabetes Mellitus / epidemiology*,  ethnology,  physiopathology*
Echocardiography, Doppler
Follow-Up Studies
Heart Rate
Hypertension / epidemiology*,  ethnology,  physiopathology*
Indians, North American / statistics & numerical data
Middle Aged
Myocardial Contraction*
Obesity / epidemiology*,  ethnology,  physiopathology*
Research Design
Stroke Volume
United States / epidemiology
Vascular Resistance
Ventricular Function, Left
Grant Support
Reg. No./Substance:
0/Biological Markers

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