Myocardial Performance Assessment in Cardiovascular Disease

Myocardial performance assessment integrates measures of both systolic and diastolic function to provide a comprehensive gauge of cardiac health. Widely adopted metrics include the myocardial performance index (MPI), which synthesises isovolumic contraction and relaxation times with ejection time to reflect global ventricular performance. Conventional echocardiographic modalities such as tissue Doppler imaging and pulsed‐wave Doppler offer non‐invasive estimates of time intervals, while advanced techniques—speckle‐tracking echocardiography, three‐dimensional imaging and cardiac magnetic resonance—enable quantification of strain, torsion and volumetric changes. These assessments inform risk stratification across a spectrum of disorders, from hypertension and diabetes to acute coronary syndromes and chronic heart failure. By characterising subtle impairments in contractile and filling phases, they guide clinical decision‐making, monitor response to therapies and support early intervention. Despite robust validation, challenges remain in attaining standardised acquisition, overcoming operator dependence, and integrating new biomarkers with established parameters. Ongoing innovation seeks to bridge these gaps through automated analysis, wearable sensor platforms and machine‐learning algorithms that promise real-time evaluation of ventricular mechanics in ambulatory settings.

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Myocardial Performance Assessment in Cardiovascular Disease publication trend

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Technical terms

Myocardial performance index (MPI): A dimensionless ratio defined as (isovolumic contraction time + isovolumic relaxation time) / ejection time, reflecting combined systolic and diastolic function.

Isovolumic contraction time (IVCT): Interval between mitral valve closure and aortic valve opening, representing the period of ventricular pressure rise without volume change.

Isovolumic relaxation time (IVRT): Interval between aortic valve closure and mitral valve opening, representing the phase of ventricular pressure fall before filling commences.

Left ventricular ejection time (LVET): Duration from aortic valve opening to closure, indicating the period of blood ejection from the ventricle.

Tissue Doppler imaging (TDI): Echocardiographic technique that measures myocardial velocity at specific sites, enabling calculation of contraction and relaxation time intervals.

References

1. Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study. Clinical Research in Cardiology (2023).
2. Changes in cardiac time intervals over a decade and the risk of incident heart failure: The Copenhagen City Heart Study. International Journal of Cardiology (2023).
3. Association between cardiac time intervals and incident heart failure after acute coronary syndrome. The International Journal of Cardiovascular Imaging (2024).