Tissue Doppler septal Tei index indicates severity of illness in pediatric patients with congestive heart failure

Aura A. Sanchez Mejia, Kathleen E. Simpson, Charles F. Hildebolt, Elfriede Pahl, Kathleen L. Matthews, Cheryl A. Rainey, Charles E. Canter, Patrick Y. Jay, Mark C. Johnson

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


The Doppler Tei index is an independent predictor of outcomes in adult heart failure. Tissue Doppler imaging (TDI) may be a superior method to measure the Tei index in children because it is less affected by heart rate variability. We hypothesized that the TDI Tei index reflects severity of illness in pediatric heart failure. Twenty-five pediatric heart failure patients were prospectively enrolled. Listing for heart transplantation or death were the outcomes used to define severity of illness. Baseline demographics, brain natriuretic peptide (BNP), and standard echocardiographic and TDI-derived parameters were analyzed to determine outcome indicators. Ten of the 25 patients (40 %) were listed for transplantation. There were no deaths. Multivariate analysis combining age, heart rate, standard echocardiographic parameters, and BNP resulted in shortening fraction (p = 0.002) as the best indicator of listing for transplantation (R 2 = 0.32). A second multivariate analysis combining age, heart rate, TDI parameters, and BNP resulted in age (p = 0.03) and septal Tei index (p = 0.03) as the best predictive model (R 2 = 0.36). The area under the receiver operating characteristic (ROC) curve for septal Tei index was 0.84 (95 % confidence interval = 0.64-0.96,), and it was comparable with the ROC curve for shortening fraction, p = 0.76. Optimal values of sensitivity (100 %) and specificity (60 %) were obtained with septal Tei index values >0.51. The TDI septal Tei index is an indicator of disease severity in pediatric heart failure patients and offers potential advantages compared with standard echocardiographic measures of left-ventricular ejection.

Original languageEnglish (US)
Pages (from-to)411-418
Number of pages8
JournalPediatric Cardiology
Issue number3
StatePublished - Mar 2014

Bibliographical note

Funding Information:
Support for this project was provided by an interdisciplinary research initiative grant from the Children’s Discovery Institute, a partnership of Washington University and St. Louis Children’s Hospital. Additional support was provided by the Washington University Institute of Clinical and Translational Sciences Grant No. UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.


  • Heart failure
  • Tei index
  • Tissue Doppler


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