Left ventricular Tei index: a simple yet powerful tool for preoperative risk stratification in cardiac surgery

Abstract Introduction Left ventricular ejection fraction (LVEF) has traditionally been the standard parameter for assessing cardiac function. However, its sensitivity for detecting subclinical dysfunction is limited. The left ventricular myocardial performance index (MPI), also known as the left ventricular Tei index, integrates both systolic and diastolic time intervals, offering a more comprehensive evaluation of global left ventricular performance, particularly in the perioperative setting. Purpose To evaluate the prognostic value of the preoperative left ventricular MPI in patients undergoing cardiac surgery with cardiopulmonary bypass and its association with early postoperative adverse outcomes. Methods This cross-sectional, observational, retrospective study was conducted at a tertiary care centre. A total of 140 adult patients who underwent cardiac surgery with cardiopulmonary bypass between June 2022 and April 2023 were included. Preoperative clinical, echocardiographic, and haemodynamic data were collected. Patients were stratified by Tei index: normal (<0.49) and abnormal (>0.49). Results An abnormal left ventricular Tei index was identified in 29.3% of patients. No significant difference in LVEF was found between groups (mean 52.9% vs. 51.6%; p =0.59), underscoring LVEF’s limited capacity to detect subclinical myocardial dysfunction. In contrast, patients with elevated MPI had a significantly higher incidence of low cardiac output syndrome (34.15% vs. 2.02%; p <0.001), increased need for inotropic support (dobutamine, vasopressin, levosimendan), lower mixed venous oxygen saturation (p = 0.0003), higher central venous-to-arterial carbon dioxide difference (p = 0.0329), and a trend toward hyperlactatemia at 6 hours. This group also showed a greater prevalence of advanced diastolic dysfunction (grade III: 30.6%vs.19.5%) and type 2 diabetes mellitus (36.6% vs. 21.2%), suggesting subclinical diabetic cardiomyopathy. Patients with an abnormal index had a more complicated postoperative course, including higher rates of acute kidney injury (p =0.028), need for renal replacement therapy (p =0.042), delirium (p =0.030), hospital-acquired pneumonia (p =0.001), and red blood cell transfusion (p =0.020). Although SOFA scores at 24 and 72 hours were not statistically significant, consistently higher values were observed. In-hospital mortality was slightly higher (4.88%vs.3.06%), though not significant. Conclusion The left ventricular MPI demonstrated high sensitivity for detecting global myocardial dysfunction, correlating with a higher incidence of postoperative haemodynamic and systemic complications, even in patients with preserved LVEF. Its strong association with diastolic dysfunction and type 2 diabetes reinforces its utility in identifying subclinical myocardial impairment. Given its accessibility, reproducibility, and prognostic value, the left ventricular MPI is a valuable tool for enhancing preoperative risk stratification in cardiac surgery.