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The prognostic value of Tei index in acute myocardial infarction: a systematic review


Background:Echocardiographic evaluation of left ventricular ejection fraction (LVEF) is used in the risk stratification of patients with an acute myocardial infarction (AMI). However, the prognostic value of the Tei index, an alternative measure of global cardiac function, in AMI patients is not well established.

Methods:We conducted a systematic review, using MEDLINE and EMBASE, to evaluate the prognostic value of the Tei index in predicting adverse outcomes in patients presenting with AMI. The data was collected and narratively synthesised.

Results:A total of 16 studies were including in this review with 2886 participants (mean age was 60 years from 14 studies, the proportion of male patients 69.8% from 14 studies). Patient follow-up duration ranged from during the AMI hospitalisation stay to 57.8 months. Tei index showed a significant association with heart failure episodes, reinfarction, death and left ventricular thrombus formation in 14 out of the 16 studies. However, in one of these studies, Tei index was only significantly predictive of cardiac events in patients where LVEF was <40%. In two further studies, Tei index was not associated with predicting, adverse outcomes once LVEF, left ventricular end-systolic volume index and left ventricular early filling time was taken into consideration. In the two remaining studies, there was no prognostic value of Tei index in relation to patient outcomes.

Conclusion:Tei index may be an important prognostic marker in AMI patients, however, more studies are needed to better understand when it should be used routinely within clinical practice


  1. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function–a study in normals and dilated cardiomyopathy. Journal of Cardiology 1995 26 357–366.

    CAS  PubMed  Google Scholar 

  2. Eto G, Ishii M, Tei C, Tsutsumi T, Akagi T, Kato H Assessment of global left ventricular function in normal children and in children with dilated cardiomyopathy. Journal of the American Society of Echocardiography 1999 12 1058–1064. (

    Article  CAS  Google Scholar 

  3. Karatzis EN, Giannakopoulou AT, Papadakis JE, Karazachos AV, Nearchou NS Myocardial performance index (Tei index): evaluating its application to myocardial infarction. Hellenic Journal of Cardiology 2009 50 60–65.

    PubMed  Google Scholar 

  4. Kim WH, Otsuji Y, Yuasa T, Minagoe S, Seward JB, Tei C Evaluation of right ventricular dysfunction in patients with cardiac amyloidosis using Tei index. Journal of the American Society of Echocardiography 2004 17 45–49. (

    Article  Google Scholar 

  5. Nunes MC, Barbosa MM, Ribeiro ALP, Colosimo EA, Rocha MOC Left atrial volume provides independent prognostic valve in patients with Chagas cardiomyopathy. Journal of the American Society of Echocardiography 2009 22 82–88. (

    Article  Google Scholar 

  6. Abuomara HZA, Hassan OM, Rashid T, Baraka M Myocardial performance index as an echocardiographic predictor of early in-hospital heart failure during first acute anterior ST-elevation myocardial infarction. Egyptian Heart Journal 2018 70 71–75. (

    Article  Google Scholar 

  7. Migrino RQ, Young JB, Ellis SG, White HD, Lundergan CF, Miller DP, Granger CB, Ross AM, Califf RM, Topol EJ End-systolic volume index at 90 to 180 minutes into reperfusion therapy for acute myocardial infarction is a strong predictor of early and late mortality. The global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO)-I angiographic investigators. Circulation 1997 96 116–121. (

    Article  CAS  Google Scholar 

  8. Sutton MStJ, Pfeffer MA, Plappert T, Rouleau JL, Moyé LA, Dagenais GR, Lamas GA, Klein M, Sussex B, Goldman S Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation 1994 89 68–75. (

    Article  Google Scholar 

  9. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. European Heart Journal 2008 29 2909–2945. (

    Article  Google Scholar 

  10. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA, Mullany CJ et al. 2007 Focused update of the ACC/AHA 2004 Guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing group to review new evidence and update the ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction). Journal of the American College of Cardiology 2008 51 210–247.

    Article  Google Scholar 

  11. Møller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pillikka PA Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. American Heart Journal 2006 151 419–425. (

    Article  Google Scholar 

  12. Burns RJ, Gibbons RJ, Yi Q, Roberts RS, Miller TD, Schaer GL, Anderson JL, Yusuf S CORE Study Investigators. The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. Journal of the American College of Cardiology 2002 39 30–36. (

    Article  Google Scholar 

  13. Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Boersma E, Holman ER, Van der Wall EE, Schalij MJ, Bax JJ Prognostic importance of strain and strain rate after acute myocardial infarction. European Heart Journal 2010 31 1640–1647. (

    Article  Google Scholar 

  14. Szymański P, Rezler J, Stec S, Budaj A Long-term prognostic value of an index of myocardial performance in patients with myocardial infarction. Clinical Cardiology 2002 24 378–383.

    Article  Google Scholar 

  15. Møller JE, Sondergaard E, Poulsen SH, Egstrup K The Doppler echocardiographic myocardial performance index predicts left-ventricular dilation and cardiac death after myocardial infarction. Cardiology 2001 95 105–111. (

    Article  Google Scholar 

  16. Møller JE, Egstrup K, KØber L, Poulsen SH, Nyvas O, Torp-Pederson C Prognostic importance of systolic and diastolic function after acute myocardial infarction. American Heart Journal 2003 145 147–153. (

    Article  Google Scholar 

  17. Rahman N, Kazmi KA, Yousaf M Non-invasive prediction of ST elevation myocardial infarction complications by left ventricular Tei index. Journal of the Pakistan Medical Association 2009 59 75–78.

    PubMed  Google Scholar 

  18. Sasao H, Noda R, Hasegewa T, Endo A, Oimatsu H, Takada T Prognostic value of the Tei index combining systolic and diastolic myocardial performance in patients with acute myocardial infarction treated by successful primary angioplasty. Heart and Vessels 2004 19 68–74. (

    Article  Google Scholar 

  19. Schwammenthal E, Adler Y, Amichai K, Sagie A, Behar S, Hod H, Feinberg MS Prognostic value of global myocardial performance indices in acute myocardial infarction: comparison to measures of systolic and diastolic left ventricular function. Chest 2003 124 1645–1651. (

    Article  Google Scholar 

  20. Westholme C, Johnson J, Jernburg T, Winter R The prognostic value of mechanical left ventricular dyssynchorny in patients with acute coronary syndrome. Cardiovascular Ultrasound 2013 11 35. (

  21. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. Ottowa, Canada: Ottawa Hospital Research Institute, 2000. (available at:

    Google Scholar 

  22. Biering-Sørensen T, Mogelvang R, Søgaard P, Pedersen SH, Galatius S, Jørgensen PG, Jensen JS Prognostic value of cardiac time intervals by tissue Doppler imaging M-mode in patients with acute ST-segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. Circulation: Cardiovascular Imaging 2013 6 457–465. (

    Google Scholar 

  23. Hole T, Skjærpe T Myocardial performance index (Tei index) does not reflect long-term changes in left ventricular function after acute myocardial infarction. Echocardiography 2003 20 1–7. (

    Article  Google Scholar 

  24. Karvounis HI, Nouskas IG, Farmakis TM, Vrogistinos KM, Papadopoulos CE, Zaglavara TA, Parharidis GE, Louridas GE Evaluation of a Doppler-derived index combining systolic and diastolic left ventricular function in acute myocardial infarction. Angiology 2004 55 21–28. (

    Article  Google Scholar 

  25. Souza LP, Campos O, Peres CA, Machado CV, Carvalho AC Echocardiographic predictors of early in hospital heart failure during first ST elevating acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function? Cardiovascular Ultrasound 2011 9 17. (

  26. Uzunhasan I, Bader K, Okςun B, Hatemi AC, Mutlu H Correlation of the Tei index with left ventricular dilatation and mortality in patients with acute myocardial infarction. International Heart Journal 2006 47 331–342. (

    Article  Google Scholar 

  27. Yilmaz R, Celik S, Baykan M, Orem C, Kasap H, Durmus I, Erdol C Pulse wave tissue Doppler-derived myocardial performance index for the assessment of left ventricular thrombus formation risk after acute myocardial infarction. American Heart Journal 2004 148 1102–1108. (

    Article  Google Scholar 

  28. Yusas T, Otsuji Y, Kuwahara E, Takasaki K, Yoshifuku S, Yuge K, Kisanuki A, Toyonaga K, Lee S, Toda H et al. Noninvasive prediction of complications with anteroseptal acute myocardial infarction by left ventricular Tei index. Journal of the American Society of Echocardiography 2005 18 20–25. (

    Article  Google Scholar 

  29. Zamfir D, Pitic D, Tamasescu G, Onciul S, Tăutu O, Angelescu C, Onut R, Stoian M, Dorobantu M Prognostic value of right ventricular function assessed by echocardiography in patients presenting with a first acute ST elevation myocardial infarction treated by primary PCI. Revista Medico-Chirurgicala a Societatii de Medici si Naturalisti din Iasi 2016 120 824–833.

    PubMed  Google Scholar 

  30. Cikes M, Solomon SD Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. European Heart Journal 2016 37 1642–1650. (

    Article  Google Scholar 

  31. Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK, Warnica JW, Khrakovskaya M, Arnold JM, Schwartz Y et al. Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation 2005 111 3411–3419. (

    Article  CAS  Google Scholar 

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Bennett, S., Wong, C.W., Griffiths, T. et al. The prognostic value of Tei index in acute myocardial infarction: a systematic review. Echo Res Pract 7, 49–58 (2020).

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Key Words

  • echocardiography
  • Tei index
  • myocardial performance index
  • myocardial infarction
  • prognosis