Sudden drop in Ejection Fraction

[alan_delac]

43 years old, bicuspid aortic valve, regurgitation.
Last Saturday I got call from my cardiac surgeon. My latest echo shows 44% ejection fraction while about 6 months ago it was 58%. That would be a trigger for surgery. I was a bit surprised, as subjectively I don't feel any different. I have asked for one more echo to confirm the result. If confirmed I have to look into valve selection and timing of my surgery. At the moment I'm inclined toward tissue valves.
Any words of wisdom?

Alan

 

[Ross]

Don't get to riled up over echo's. They vary widely. Have you had a catheterization yet? I'd start worrying if other tests are saying the samething, but echo's, in my opinion, are not a very good diagnostic tool.

 

[tobagotwo]

I believe your request for another echo was a wise one, as I agree with Ross that they can vary quite a bit. A change in EF without other concurrent changes or symptoms should initially raise more suspicion about the individual test results than your heart status. It can be helpful to get the echo from the same tech each time, as you can have a progression to watch.

One problematic thing is that the techs frequently want the previous results, and use them as a pattern for the current results. Maybe you don't want them to use the previous results this time.

Unfortunately, all of the diagnostic tools seem to have room for error, in either direction. That includes cardiac catheterizations and MRAs, as well as echoes. Under most circumstances, you will have a cath if you are scheduled for surgery anyway, to check for coronary artery bypass graft (CABG) possibilities during surgery. That provides something of a reality check against the echoes before the deed is done. In my case and several others, the valve actually turned out to be worse than the echo and the cath predicted, although the echo was closer in my case. And my cath showed that I had a bicuspid valve, which turned out not to be the case. It goes the other way too, though.

I don't know if you're hoping for some more time, or to just get it over with for now, but I hope the re-echo goes the way that works best for you.

Best wishes,

 

[bvdr]

Alan, if you are going to need it done anyway then what does it really matter if you have it a bit earlier than you planned? Unless, of course, it would sway you towards or away from a tissue valve. I have a mechanical mitral and I am used to the coumadin regime but would rather not have to be on it. I would rather be on it then face another OHS though. In my case, I may need another surgery sometime in the future on my aortic valve anyway... so nothing is set in stone. Sometimes people with tissue valves end up on coumadin for atrial fib as well.

Do your research, make your choice, but don't fret too much over it. There are so many good choices these days but in the end, your surgeon will make the call after he opens you up and the result of it all is ultimately rests in God's handsl

My EF dropped from in the high sixties/low seventies to about 50% in about six months time. It corresponded with starting to feel really poorly. The reading for EF can change day to day but a really well done echo can give a good estimate. I don't like the idea of basing the readings of one echo on the readings of another either as that seems like a good way to compound errors. I can understand seeing trends that way or a more or less than comment when comparing echo to echo. I went into surgery based on how I was feeling and primarily echo results. The surgeon said afterwards that it was definitely time to fix the problem.

Keep in touch and let us know how you are doing with the decision process.

 

[alan_delac]

Dear all,

Thanks for your comments, I really appreciate your insights. Here is my heart history:

· I was 18 years old when my regurgitation was discovered, my heart size was still within normal limits
· At age 28 years echo showed a significant increase in size, LV = 64mm. Fortunately I was unaware of seriousness of my problem. Shortly after I migrated to Australia.
· As I felt quite good I avoided doctors for the next 13 years.
· Last year I decided to check my heart and found that not much has changed in those 13 years (LV = 63mm). First cardiologist that I've seen wanted me to have an operation strait away. As he wouldn't explain and discuss the recommendation I decided to change my cardiologist.
· Since then I spoke several time to my cardiac surgeon with an agreement to have eco every 6 months.

Someone could ask why don't I just do it and get on with my life. Well, if that first cardiologist saw me 14 years ago I would have had an operation then, and would live with all the associated complications. I lived fairly care free life those 14 years and would like to continue for a few more years if I feel good and there is no significant deterioration of my heart. There is always a chance that a new longer lasting or better performing valve will appear in the near future. The other thing is durability of tissue valves that are my choice at the moment. I'm 43 years now and say a tissue valve lasts 12 years I'll be 55 for my second operation meaning I would have to look into mechanical or a third operation. If I get lucky and have my first operation when I'm 48-50, the valve would probably last longer and only 2 operations would be required.
I feel good being moderately active but I'm very careful not to push myself too hard, take antibiotics when required and listen to my heart.
If it is time to do it based on some generally accepted criteria I won't hesitate because too much is at stake.

Thanks again

Alan

 

[Marge]

I know I am late with this reply, I see your last post was several days ago, Alan -- but I haven't been coming to the site much recently, for a variety of reasons.
Your original post caught my eye because I also had a reading on an echocardiagram that seemed to indicate my EF had gone down very fast. I supposedly had an EF of 45 at the time of my discharge from hospital in February according to the hospital discharge summary. Then in July I had an echo and the report indicated an EF of 30! Which really shocked me.
My cardio told me that echos can be very approximate and the readings are subjective and I really should not worry as long as I felt OK and didn't have any overt symptoms like SOB, etc. But I couldn't help worrying & finally (I think to shut me up) he sent me out for a different test, a MUGA (Multi Gated Acquisition) which is supposed to be much more accurate in determining EF than echocardiogram.
Well, guess what, my EF on the MUGA is 53!!!!! Which is actually within normal range. Low normal, but normal & a heck of a lot more reassuring than 30.
So when you are trying to decide what happens next, you might ask your cardio whether a MUGA test might be helpful.

 

[Gnusgal]

My cardiologist has gotten to where she doesn't rely on echos for reading my ejection fraction anymore. It's just too hard with all of my scar tissue. She orders a MUGA every year. They aren't too bad. Just be sure you don't get horrible techs who don't know how to put in an IV and its quite the boring procedure. They are supposed to be the best at reading EF, other than cath (and no one wants one of THOSE once a year!).

 

[alan_delac]

Thank you all,

What you tell me is very useful. I'm not going to make any decision just based on the echo ejection fraction results.

Alan