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

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.