A Comparison of Tei Index Versus Systolic to Diastolic Ratio to Detect Left Ventricular Dysfunction in Pediatric Patients

Background: The aim of this study was to determine the accuracy, sensitivity, specificity, predictive values, and likelihood ratios of the left ventricular (LV) Tei index (TX) and the ratio of systolic duration to diastolic duration (S/D) to detect ventricular dysfunction. Methods: LV systolic and diastolic function were studied in a cohort of 68 children, 25 normal and 43 abnormal. Systolic dysfunction was defined as the presence of all of 3 criteria: ejection fraction < 50%, fractional shortening < 27%, and tissue Doppler systolic S wave < 1.5 standard deviations below normal (Z - 1.5). Diastolic dysfunction was defined as the presence of all of 3 criteria: isovolumic relaxation time corrected for heart rate > 88 ms, ratio of transmitral Doppler flow early diastolic velocity (E) to mitral valve annular early diastolic tissue Doppler velocity (E′) > 13, and E′ < Z - 1.5. The cohort was divided into 4 groups: normal systolic and diastolic function, systolic dysfunction, diastolic dysfunction, and combined systolic and diastolic dysfunction. TX > 0.5 and S/D > 1.0 were defined as abnormal. TX and S/D results were compared with normal function versus abnormal function categories using 2 × 2 classification tables and receiver operating characteristic curves. Results: The overall accuracy of TX was 85%, and that of S/D was 82%. TX was most accurate (92%) for detecting diastolic and combined dysfunction, whereas S/D had similar accuracy for all LV function groups. The overall accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of TX were slightly greater than those for S/D for almost all categories. Conclusion: The overall accuracy, sensitivity, specificity, predictive values, and likelihood ratios of TX are slightly greater than those of S/D for most categories of dysfunction, although either may fail to detect dysfunction in 15% to 18% of cases. When both TX and S/D are used in combination, using the presence of either TX > 0.5 or S/D > 1.0 as indicative of dysfunction, few cases of LV dysfunction should elude detection.