Update on sudden drop in Ejection Fraction

[alan_delac]

My last echo calculated 44% EF that is a fair drop from 58% 6 months ago. Just to be sure I repeated the echo and got 56% but there were some strange results.
My LVD was 55mm (usually 64mm) and my LV volume was measured 172mls (usually about 215mls). That is strange. My surgeon said that my last results could have been influenced by stress and adrenaline made heart pump better. We'll repeat echo in 3 months.
I must admit that during the first echo I went into some sort of meditation to relax from work and life (it was very successful) and later I thought that it could have influenced my EF going down to 44%. During second echo I decided to stay alert but I wouldn't say I was very tight although lately I had some stressful events in my life.

Now I just want to rest from all these tests for a while and in 3 months we'll see.


Alan

 

[PapaHappyStar]

Alan - I think I made the same mistake of reading too much into measurements.

There are a few things one needs to consider:

-- What is the percentage error ( random and systematic ) in computing the EF -- dosent sound that easy to measure, I imagine it depends on the estimation of
a) volume per stroke
b) volume of the ventricle

so EF = a/b ; i.e. if b goes down then EF goes up -- now the question is how and when do they measure the ventricular volume ( and from what angle ) these are all tricky things with a single ultrasonic probe ( 2D ) -- I wouldnt read too much into the variation in the EF.

Also in this digital age it is difficult to understand even for some physicians that the human body is very analog and highly complex both of which dont lead to digitally reproducible measurements.

Burair

 

[PapaHappyStar]

Alan - Did anyone recommend a change in your treatment based on the drop in EF?

 

[alan_delac]

Hi,

Well, once EF drops below 50%, AVR operation should be done. As I feel reasonably good, I am not too keen to do it unless there is a strong reason. In this case EF value would be a trigger and I want to be sure it is below 50% before I go for an operation.

Alan

 

[PapaHappyStar]

Alan

You are right about the 50% mark:

http://www.acc.org/clinical/guidelines/valvular/jac5929fla16.htm#B3g
http://www.acc.org/clinical/guidelines/valvular/jac5929fla16.htm#B3h3

You probably meet this recommendation as well:

http://www.acc.org/clinical/guidelines/valvular/jac5929rec9.htm

Their number for the EF from my cardiac MRI was 49% ( around a month ago ) valve area 0.4 cm^2 ( 80 mmHg gradient )
My first echo gave: 55% ( five months ago ) valve area 1.2 cm^2 ( 26mmHg mean gradient)
Second echo and a cath: 65% ( two months ago ) valve area 0.6 cm^2 ( around 60 mmHg gradient )

This says severe AS to me and that I shouldnt wait for symptoms to have surgery.

Burair