Prognostic Role of Myocardial Performance Index on Long‐Term Survival after Heart Transplantation: A Prospective Study

Abstract

The survival rate of heart transplant patients is increasing, underlying the need for accurate predictors of adverse events during clinical follow-up. Myocardial performance index (MPI) is a Doppler-derived index of combined systolic and diastolic function: we assessed the prognostic role of MPI in survival of patients >1 year after heart transplantation (HT). A total of 152 consecutive HT patients referred to our institution were enrolled in this prospective study. Primary endpoints were cardiac death and a composite of major adverse cardiac events (MACE). During follow-up (69 ± 22 months), 68 (44.7%) patients had an adverse event and 20 (13.15%) patients died. Patients with MACE during follow-up showed lower EF (57.3 ± 9.3 vs. 63 ± 6.1; P < 0.001) and higher MPI (0.45 ± 0.19 vs. 0.31 ± 0.13; P < 0.001) at enrolment. MPI and EF were independently related to MACE (OR = 2.2; 95% confidence interval [CI] = 1.01-5.1; and OR = 6.6; 95% CI = 3.5-11.2, respectively) and showed strong diagnostic power (MPI: receiver operating characteristic [ROC] area = 79%, with 79% sensitivity and 81% specificity; EF: ROC area = 77%, with 54% sensitivity and 91% specificity) in the subsequent year. Patients with EF > 50% and MPI < 0.45 at enrolment showed 75% event-free survival 5 years after HT. In HT patients, MPI combined with EF was an accurate means of predicting long-term adverse events.

New echocardiographic insights in short QT syndrome: More than a channelopathy?

“…18,19 MPI was previously studied as a diagnostic and prognostic tool in idiopathic dilated cardiomyopathy 18 and other structural cardiac diseases such as amyloidosis and heart transplantation. 20 As we did not observe a significant change in isovolumic contraction and relaxation times, the higher MPI must be driven by the reduced ejection time. Whether the impaired MPI is a mere numerical result of the accelerated repolarization or a marker of reduced contractility is a challenging question.…”

Does asymptomatic recurrent diffuse capillary C4d complement deposition impair cardiac allograft function?

“…All mean values result from at least three different measurements, five if arrhythmia occurred. EF≤50% and MPI≥0.45, as previously demonstrated as prognostic factors, and posterolateral S′ ≤10 cm/s, as a marker of CAV, were the pre‐specified parameters of LV impaired function.…”

Effect of food intake on myocardial performance index

“…Myocardial performance index has been used to investigate different populations, such as patients with heart failure [2], acute myocardial infarction [3], heart transplants [4], COPD [25], patients with chronic ischemic cardiomyopathy who have undergone revascularization [26], as well as in healthy young men during high altitude exposure [27]. MPI has also been investigated in relation to age [28].…”

“…MPI has been examined in many studies in a variety of populations over the last two decades, and has been used as a measure of total left ventricular function. It has been used for prognostic examinations of patients regarding heart failure [2], acute myocardial infarction [3] and heart transplants [4], as well as in healthy athletes [5] and in yoga practitioners with heart failure [6]. MPI has also been used in several studies regarding pediatric patients; for example helping to detect acute cellular rejection after heart transplant [7], for early detection of chemo-induced cardiotoxicity [8], in investigations concerning cardiovascular changes in children with bicuspid aortic valves [9], and for assessment of ventricular function in obese children [10].…”