Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2008 Sep 9;31(9):424–430. doi: 10.1002/clc.20264

Is Myocardial Performance Index an Independent Echocardiographic Marker of Death in Children with Idiopathic Dilated Cardiomyopathy?

Vitor Manuel P Azevedo 1,✉, Francisco M Albanesi Filho 2, Marco Aurélio Santos 1, Márcia B Castier 2, Bernardo R Tura 1, José Geraldo Amino 1, Maria Ourinda Mesquita Da Cunha 1
PMCID: PMC6652866  PMID: 18781602

Abstract

Background

Myocardial performance index (MPI) was reported as a parameter of ventricular systolic and diastolic function, as well as a useful tool to predict the outcome in patients with ventricular dysfunction.

Hypothesis

To compare MPI with classical echocardiographic parameters as an independent marker of death in children with idiopathic dilated cardiomyopathy (IDCM).

Methods

Fifty‐five children (13 deaths) underwent 104 echocardiograms from January 1996 to May 2005. Right ventricle (RV) MPI and left ventricle (LV) MPI, and 9 classical echocardiographic parameters (left atrium [LA]/body surface area [BSA], distance between mitral E point and ventricular septum, LV mass/body surface area, RV shortening fraction, LV end‐systolic and end‐diastolic dimensions/body surface area, LV ejection fraction, fiber circumferential shortening velocity, and mitral deceleration time) were compared. Statistical analysis was performed by chi‐square, Pearson's correlation and Student t‐test, Kaplan‐Meier method, Cox's method, and receiver operating curve (ROC). Statistical significance was considered with α< 0.05 and p = 0.80].

Results

Univariate analysis showed that all studied parameters were markers of death. There was a high correlation between RVMPI and LVMPI (r = 0.847]–p = 0.0001]); therefore, to avoid bias, RVMPI was discharged from multivariate analysis. In the deceased group, moderate/severe mitral regurgitation was frequent (76.9%; confidence interval [CI[ 95% = 46.2%– 94.9%) and it was considered in multivariate analysis. In Cox's multivariate analysis, LVMPI was the only independent marker of death (p = 0.0213]). The ideal cut‐off was 0.63 with 92.3% sensitivity, 66.7% specificity, and fitted ROC area = 0.918].

Conclusions

In children with IDCM, LVMPI is an independent marker of death. Copyright © 2008 Wiley Periodicals, Inc.

Keywords: heart failure, cardiomyopathy, cardiac transplantation, pediatric clinical cardiology, echocardio‐ graphy

Full Text

The Full Text of this article is available as a PDF (643.7 KB).

References

  • 1. Talner NS: Heart failure In: Moss AJ, Adams FH, eds. Heart Disease in Infants, Children and Adolescents. 5th ed Baltimore, MD: Williams and Wilkins; 1995; 1746–1773. [Google Scholar]
  • 2. Lewis AB: The failing myocardium In: Chang AC, Hanley FL, Wernovsky G, Wessel DL, eds. Pediatric Cardiac Intensive Care. 1st ed Baltimore, MD: Williams and Wilkins; 1998; 483–496. [Google Scholar]
  • 3. Richardson P: Report of the 1995 World Health Organization /International Society and Federation of Cardiology task force on the definition and classification of cardiomyopathies. Circulation 1996; 93: 841–842. [DOI] [PubMed] [Google Scholar]
  • 4. Matitiau A, Perez‐Atayde A, Sanders SP, Sluysmans T, Parness IA, et al.: Infantile dilated cardiomyopathy–relation of outcome to left ventricular mechanics, hemodynamics and histology at the time of presentation. Circulation 1994; 90: 1310–1318. [DOI] [PubMed] [Google Scholar]
  • 5. Arola A, Tuominen J, Ruuskanen O, Jokinen E: Idiopathic dilated cardiomyopathy in children: prognostic indicators and outcome. Pediatrics 1998; 101: 369–376. [DOI] [PubMed] [Google Scholar]
  • 6. Akagi T, Benson LN, Lightfoot N, Chin K, Wilson G, et al.: Natural history of dilated cardiomyopathy in children. Am Heart J 1991; 121: 1502–1506. [DOI] [PubMed] [Google Scholar]
  • 7. Wong PC, Starnes VA: Pediatric heart and lung transplantation In: Chang AC, Hanley FL, Wernovsky G, Wessel DL, eds. Pediatric Cardiac Intensive Care. 1st ed Baltimore, MD: Williams and Wilkins; 1998; 327–343. [Google Scholar]
  • 8. Azeka E, Barbero‐Marcial M, Jatene M, Camargo PR, Auler JO, et al.: Heart transplantation in neonates and children. Intermediate‐term results. Arq Bras Cardiol 2000; 74: 197–202. [DOI] [PubMed] [Google Scholar]
  • 9. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, et al.: New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function–a study in normal and dilated cardiomyopathy. J Cardiol 1995; 26: 357–366. [PubMed] [Google Scholar]
  • 10. Zoghbi WA, Enriquez‐Sarano M, Foster E, Grayburn PA, Kraft CD, et al., American Society of Echocardiography: Recommendations for evaluation of the severity of native valvular regurgitation with two‐dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16: 777–802. [DOI] [PubMed] [Google Scholar]
  • 11. Azevedo VMP, Albanesi Filho FM, Santos MA, Castier MB, Tura BR: How can the echocardiogram be useful for predicting death in children with idiopathic dilated cardiomyopathy? Arq Bras Cardiol 2004; 82: 510–514. [DOI] [PubMed] [Google Scholar]
  • 12. Lewis AB: Late recovery of ventricular function in children with idiopathic dilated cardiomyopathy. Am Heart J 1999; 138: 334–338. [DOI] [PubMed] [Google Scholar]
  • 13. Torres F, Anguita M, Tejero I, Gimenez D, Franco M, et al.: Acute myocarditis with severe cardiac dysfunction in the pediatric population. The evolution and differential characteristics with respect to adult myocarditis. Rev Esp Cardiol 1995; 48: 660–665. [PubMed] [Google Scholar]
  • 14. Lipshultz SE, Easley KA, Orav EJ, Kaplan S, Starc TJ, et al.: Left ventricular structure and function in children infected with human immunodeficiency virus: the prospective P2C2 HIV multicenter study. Pediatric pulmonary and cardiac complications of vertically transmitted HIV infection (P2C2 HIV) study group. Circulation 1998; 97: 1246–1256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Kimball TR, Daniels SR, Meyer RA, Schwartz DC, Kaplan S: Left ventricular mass in childhood dilated cardiomyopathy: a possible predictor for selection of patients for cardiac transplantation. Am Heart J 1991; 122: 126–131. [DOI] [PubMed] [Google Scholar]
  • 16. Engle SJ, DiSessa TG, Perloff JK, Isabel‐Jones J, Leighton J, et al.: Mitral valve E point to ventricular septal separation in infants and children. Am J Cardiol 1983; 52: 1084–1087. [DOI] [PubMed] [Google Scholar]
  • 17. Karagiannis SE, Karatasakis GT, Koutsogiannis N, Athanasopoulos GD, Cokkinos DV: Increased distance between mitral valve cooptation point and mitral annular plane: significance and correlations in patients with heart failure. Heart 2003; 89: 1174–1178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Nishimura RA, Appleton CP, Redfield MM, Ilstrup DM, Holmes DR Jr, et al.: Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 1996; 28: 1226–1233. [DOI] [PubMed] [Google Scholar]
  • 19. Akiba T, Yoshikawa M, Otaki S, Kobayashi Y, Nakasato M, et al.: Echocardiographic measurements of left ventricle in normal infants and children. Tohoku J Exp Med 1986; 149: 31–37. [DOI] [PubMed] [Google Scholar]
  • 20. Colan SD, Borow KM, Newman A: Left ventricular end‐systolic wall stress‐velocity of fiber shortening relation: a load‐independent index of myocardial contractility. J Am Coll Cardiol 1984; 4: 715–724. [DOI] [PubMed] [Google Scholar]
  • 21. Eto G, Ishii M, Tei C, Tsutsumi T, Akagi T, et al.: Assessment of global left ventricular function in normal children and in children with dilated cardiomyopathy. J Am Soc Echocardiogr 1999; 12: 1058–1064. [DOI] [PubMed] [Google Scholar]
  • 22. Eidem BW, Tei C, O'Leary PW, Cetta F, Seward JB: Nongeometric quantitative assessment of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly. J Am Soc Echocardiogr 1998; 11: 849–856. [DOI] [PubMed] [Google Scholar]
  • 23. Ocal B, Oguz D, Karademir S, Birgen D, Yuksek N, et al.: Myocardial performance index combining systolic and diastolic myocardial performance in doxorubicin‐treated patients and its correlation to conventional echo/Doppler indices. Pediatr Cardiol 2002; 23: 522–527. [DOI] [PubMed] [Google Scholar]
  • 24. Elbl L, Hrstkova H, Chaloupka V: The late consequences of anthracycline treatment on left ventricular function after treatment for childhood cancer. Eur J Pediatr 2003; 162: 690–696. [DOI] [PubMed] [Google Scholar]
  • 25. Azevedo VM, Albanesi Filho FM, Castier MB, Santos MA, Tura BR: Is myocardial performance index better than classic echocardiographic markers of mortality in children with idiopathic dilated cardiomyopathy? Circulation 2004; 110(Suppl III): 424, (abstr). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Azevedo VM, Albanesi Filho FM, Castier MB, Santos MA, Cunha MOM: Is Tei index the new echocardiographic golden standard for predicting the death in children with idiopathic dilated cardiomyopathy? Eur Heart J 2005; 26(Suppl I): 537, (abstr). [Google Scholar]
  • 27. McMahon CJ, Nagueh SF, Eapen RS, Dreyer WJ, Finkelshtyn I, et al.: Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study. Heart 2004; 90: 908–915. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES