Impact of preload alterations by haemodialysis on the Tei index: comparison between pulsed flow and tissue Doppler analyses

Abstract

Objective — The aim of this study is to evaluate and compare the impact of preload alterations by haemodialysis (HD) on the Tei index obtained by pulsed Doppler echocardiography (PDE-Tei index) and tissue Doppler echocardiography (TDE-Tei index).

Methods and results — Thirty-eight uraemic patients underwent echocardiography 1hour before and 1hour after HD was studied. Before HD, PDE- and TDE-Tei indices had a weak correlation (r=0.439, P=0.006). After HD, the correlation became stronger (r=0.794, P <0.001). After HD, body weight (P<0.001), early transmitral filling wave peak velocity (E) (P<0.001), early diastolic mitral annular velocity (Em) (P<0.001), and E/Em (P=0.001) decreased and PDE- (P<0.001) and TDE-Tei indices (P=0.022) increased significantly. In addition, after HD, body weight reduction had a significant correlation with E decrease and PDE- and TDE-Tei index increase (P<0.001, P=0.005, and P=0.016, respectively).A subgroup comparison showed that in patients with body weight reduction< 3kg, the PDE-Tei index (P=0.003) increased significantly but TDE-Tei index (P=0.209) did not change after HD. In patients with body weight reduction ≥ 3kg, both the PDE- and TDE-Tei indices (P=0.003 and 0.042, respectively) increased significantly after HD.

Conclusions — Both the PDE- and TDE-Tei indices are preload-dependent indicators. However, TDE-Tei index is less preload-dependent and is more accurate in assessing global left ventricular function in patients with body weight reduction<3kg after HD.

Key Words:

• Tei index
• haemodialysis
• preload