Here I Go Again

[country]

I now have two echo reports both done with in 1 month of each other with two totally diffrent EF rates. One says 30-35% while the other says 55%. Does anyone know if that is something that can change that quick?? The lower one was done first. I now have a local cardio doc that is going to do a echo stree test on Wednesday. Anyone have one of those before???

 

[perkicar]

I now have two echo reports both done with in 1 month of each other with two totally diffrent EF rates. One says 30-35% while the other says 55%. Does anyone know if that is something that can change that quick?? The lower one was done first. I now have a local cardio doc that is going to do a echo stree test on Wednesday. Anyone have one of those before???

Has your doc done a BNP lab test (for congestive heart failure)? Or changed any of your meds? That is a pretty big change over a month, but we've had patients in the hospital who've improved when we've fixed their fluid status or put them on meds that improve contractility. Remember, I'm a cancer nurse so don't really know all the meds and how they work!

 

[tobagotwo]

Carolyn makes a great point about meds and fluid.

I'm (apparently) a one-man crusade against stress testing in symptomatic valve patients, based on the AHA/ACC guidelines. Is there any thought to a TEE, MRA, or other test possibly in lieu of an exercise stress test?

Best wishes,

 

[JimChicago]

Here was an interesting article about echo tests and in it they comment about possilbe subjective interpretations at:
http://www.chfpatients.com/tests/echo.htm
>>>>
The Subjective Factor Interpreting echos involves combining one-dimensional measurements with 2D images. This combined information is added to knowledge of the patient's individual health situation to make a final report. This means that interpreting echo results is partly subjective.
Variability The doctor has to take into account the echo technique itself. Sources of variability include the patient, the echo tech, the techniques used to obtain the images, the methods used to analyze the images, the equipment, and the reader. In a study across 3 medical centers and involving nearly a dozen experienced operators, only 25% of images were judged to be "perfectly" positioned. So there can be disagreements in how to read even "standardized" techniques.
>>>>

Wouldn't doctors rely more so on symptoms than a particular test result number?

 

[perkicar]

Here was an interesting article about echo tests and in it they comment about possilbe subjective interpretations at:
http://www.chfpatients.com/tests/echo.htm
>>>>
The Subjective Factor Interpreting echos involves combining one-dimensional measurements with 2D images. This combined information is added to knowledge of the patient's individual health situation to make a final report. This means that interpreting echo results is partly subjective.
Variability The doctor has to take into account the echo technique itself. Sources of variability include the patient, the echo tech, the techniques used to obtain the images, the methods used to analyze the images, the equipment, and the reader. In a study across 3 medical centers and involving nearly a dozen experienced operators, only 25% of images were judged to be "perfectly" positioned. So there can be disagreements in how to read even "standardized" techniques.
>>>>

Wouldn't doctors rely more so on symptoms than a particular test result number?

I got that impression from listening to the docs during my visit to CC this week. My valve area was measured as 0.6 cm2 (vs 0.8 in my TEE done in November). My peak gradient was 105 vs 61 in November. And the peak gradient was 70 something in the cath (lol, after I told the doctors that Dr Lytle had said they were going to confirm it in my cath, which he DID say when we talked on Tuesday night.). But, as Dr Griffin told me, he suspects that I'm more symptomatic than I realize, but only mildly symptomatic, thank goodness.
I agree with the non-physical stress testing in a symptomatic patient. I know they'd not be getting me on a treadmill then pushing me to my limit. It could get really ugly......

 

[country]

No one has done a BNP (????) lab test, yet. and my new cardio has not changed my meds. the low ef was gotten about a month BEFORE the high one. I'm totally confused. I know that I have a stree-echo on the 23rd and on March 10 I have a Nuclear Stress test in Cincinatti. Those are the only things that I know for sure.

 

[Marge]

<<I now have two echo reports both done with in 1 month of each other with two totally diffrent EF rates. One says 30-35% while the other says 55%. Does anyone know if that is something that can change that quick?? The lower one was done first. I now have a local cardio doc that is going to do a echo stree test on Wednesday. Anyone have one of those before???>>

I don't know anything about echo stress tests -- never had one.

But your experience with the widely differing EF results makes me think of what happened to me last year. I had an echo in July 2004 which showed an EF of 30% -- which upset me because it seemed to be down considerably from the EF of 45% that I was told I had at discharge from hospital after my mitral valve repair in February 2004. My cardio was skeptical of the accuracy of the reading & (after some discussion) ordered a MUGA test.

The MUGA test was administered in September 2004 & came back with a considerably more reassuring EF of 53% -- within "normal" range (low normal, but normal).

According to my cardio, the MUGA (Multiple Gated Acquisition) test is much more precise than the echocardiagram in measuring a person's EF.

 

[country]

Thanks Marge

Thanks Marge

Thats some good info that I can ask my doctor about. I see him on Wednesday so maybe he can schedule me for that if need be. He'll be giving me the echo-stress test so I should hopefully know more then. I'll definately ask him about both the BNP and the MUGA tests.

 

[Marge]

btw, from what I've heard the MUGA test is expensive. Maybe that's why they don't do it as much as the other tests?

The upside is it's a very easy test on the patient -- much more so than the TEE (which my cardio also had me do after that suspiciously low echo).

 

[Abbanabba]

Is this measurement referring to the same part of the heart? The only reason I ask is because I have an EF of 50-55% through my LV (left ventrical), but an EF of only 35% through my pulmonary valve. I think I remember you having regurgitation through your mitral valve... maybe this is where the different reading has come from..?

If the difference in EF is from the same part of your heart, then I would definitely be very concerned and getting touch with your cardio.

All the best with your test on Wednesday. Keep us posted on how you go and what they say about your EF.

Cheers
Anna : )

 

[SHerrin Hutt]

I have had them all. There were two cardiologists that were husband and wife. One did the echo and the other did the cath. They agree to disagree on who was right as to the EF. that quite ddiffereence in the # was 25% ffor the echo & cath was 45% and the Tee wass even different at 30. In the end I still had to have aa repair and a replacement. I wish you all the luck. The Dr's in Cleveland CLinic didn't like any of the tests that I had done locally. So they did them all over again.

 

[country]

Anna

Anna

My EF% is for my left ventricle. the high ef, 55%, was from my Veterans Affair cardio at the local outpatient clinic. The low ef, 35%, is from a cardio at Ohio State University Hospital in Columbus, Ohio. Both numbers are from the LF. I'll keep you posted.

 

[Abbanabba]

Don't you just love these accurate tests they do... Hopefully your doc should be able to shed some light on this for you.

All the best,
Anna : )

 

[country]

So much for the Columbus VA outpatient clinic

So much for the Columbus VA outpatient clinic

I went down earlier to pick up a copy of the actual echo they did in January and was told that it is difficult to do and then it still may not be readable. I explained that my EX-cardiologist, who wouldn't even talk to me directly, said it would be ready to pick up this morning. He said she didn't know what it would intail. I'm starting to think thats not all she doesn't know.

Rachel-----Thanks for the info. Even my new cardio says that he has concerns as to rather or not my condition is really as bad as OSU says it is but like I told him I've lived with it for years and I know when its acting up. But I have a copy of the echo that OSU did to give him. That should give us a good starting point. Thanks again.

Stuart

 

[Laurz]

Carolyn makes a great point about meds and fluid.

I'm (apparently) a one-man crusade against stress testing in symptomatic valve patients, based on the AHA/ACC guidelines. Is there any thought to a TEE, MRA, or other test possibly in lieu of an exercise stress test?

Best wishes,

Hello Bob? Just wondering what a TEE test is as my doc wanted to do that but I don't have insurance till April so they did a second echo instead.