Hello All
New on hear but would appreciate some guidance. Been on Entresto top dose for approx months. EF has increased from 21% to 30 at last echo two weeks ago.
Been advised for referral for ICD and what I seek guidance on from contributors in the same/previous positions is 1 Will Entresto continue to increase my EF long term?2 Does an ICD improve EF ?Im aware everyone is different and results differ just seeking general knowledge
Many thanks
It depends on what your underlying condition is. An Inplantable Cardiivertor Defibrillator (ICD) will shock your heart back into rhythm. A Cardiac Resynchronisation Therapy (CRT) device will take over the timing of your heartbeat if it is too slow or irregular. Sometimes a combination of the two is required: a CRT-D.
My heart failure was caused by Supraventricular Tachycardia (SVT) which was treated by an ablation of my AV node. This caused heart block so I now have a CRT device to pace my heart.
HF due to dilated cardiomyopathy.
Thanks
But do you know the root cause?
I had HF due to dilated cardiomyopathy and Left Ventricular Systolic Dysfunction. There are several potential root causes, I believe, but it was attributed to the high ectopic burden of SVT in my case.
I'm not medically trained and don't know how entresto works other than it reduces strain on the heart. Presumably, this would explain your improvement in EF. I don't know if improvement would continue if you remain on entresto. This is a question for your cardiologist.
If an ICD is being considered, I suspect you have an arrhythmia that your cardiologist believes can be converted back to Normal Sinus Rhythm. I would guess that your cardiologist believes that your EF will improve if you keep in NSR but - again - this is a conversation you must have with your cardiologist.
Hi Ian. I have an ICD (not a CRT-D). Not only will it shock if necessary, but when my HR drops below 40, it paces it back up. It will do something similar at the top if I have VT (the reason I have it), but has not (yet) needed to do that.
Hi Alison, my husbands ICD doesn’t pace his heart. It will simply recognise an abnormal rhythm & try to correct it. But it will know within seconds if the correction hasn’t worked & it will then deliver a shock. Fortunately, it’s hasn't shocked so far but it’s really good to know that’s it’s there if needed
An ICD in itself will not improve your EF. An ICD is usually advised for people with an EF of 35 or lower. It's purely there to shock your heart if required. Entresto is recognised as one of the most effective medications for heart failure at this time. It can continue to improve EF but obviously everyone is different & of course other factors need to be taken into account, such as other medication, lifestyle etc. Also, don't get too hung up on your EF, most cardiologist are concerned with symptoms not numbers. Plus medical science is moving on all the time, who knows what will be available in a few years time, lots of studies going on into stem cell treatment. Have a look at the Pumping Marvellous website, lots of info on there and they Facebook page. Also, recommend joining the Facebook ICD-crtd support uk for more help, advice support
Thanks for the info. I just find with some cardio nurses EF appears to be the buzz word and marker for improvement i.e.:my last scan showed no mitral regurgitation (was previous) yet no mention to how this impacts on scan results.Pretty frustrating sometimes.
My husbands EF is 30, down from 35 he's had an ICD since 2012. Yes, the EF is a marker for improvement but many people have a low EF with very few, if any, symptons whereas others have an higher EF & are very symptomatic. A cardiologist is more interested in how you feel & your capabilities. We saw the Dr in Friday & he really wants my husband on Entresto but as he has low BP issues that's not possible at the moment.
Thanks for your reply and best wishes to your hubby for the future .
Same situation with my husband. He tried Entresto and started with the highest dose. It left him unable to even get out of bed. Stopped Entresto and he bounced back. He had a CRT implanted in September and the day after the surgery he got up and said "I feel great". His ejection factor is at25 but you would not know it. He just turned 84 and it's difficult to say whether it's age or the EF that slows him down. The cardiologist says the most important thing is how he feels, and the EF is only part of the equation. The CRT syncs his heart chambers and also for some reason stopped a leaky valve.
Many thanks for the pick me up advice
I'm glad your husband is doing better now he has the CRT, unfortunately my husband is not suitable for that. The thing with Entresto is, if you can tolerate it, it's a good medication to take. They've been humming & ahing bout this for my husband for bout 18 months but his BP is always an issue. Unfortunately, my husband is intolerant to the usual meds they give for HF, so if he can take this it would be so beneficial to him. At the hospital on Friday it was agreed they would tweak his other meds & hopefully get his BP up enough to try the Entresto. The downside to that is they're reducing his isobard monitrate which he takes to control his unstable angina!! So slightly worrying!! My husband is also taking part in research into how fatigue plays a part in medical conditions, it's pretty much just tick boxes on forms but up to now the attitude has pretty much been "it's one of those things!"
Hello. My husband has DCM too and he EF was 10-15% upon diagnosis 2 years ago which drug therapy (not Entresto but an ACE Inhibitor, Bisoprolol and Spironolactone) brought up to 25%. He was offered an ICD but declined. He had surgery to replace his Aortic Valve 18 months ago and his EF was still 25%. He retired last October and we got 2 puppies in November, so no more stress...his EF is now 40-45%.
So I’d say it’s more important to address any underlying causes like stress to see improvements than have an ICD (which is in case you have arrhythmia).
Whether or not you choose to have one implanted is a very personal decision and there’s no right or wrong answer as everyone is individual. For my husband he would have found the worry about it going off inappropriately and stopping him driving & riding his motorbike greater than any benefit of having the safety net of an ICD.
All the best.
Many thanks hope the hubby is doing well. I do think the stress of an ICD or not does nt help .Take care.
Meant to add to my original post I am completely asymptomatic and often walk lies 2/3 times a week.Applogies for the jumbled info.
miles
I have a CRTD and my EF went from 20% to 39% and I feel very well. It’s a biventricular pacemaker with defibrillator.
Hi, I am getting a CRT-D fitted in January, what should I expect? Did you feel an immediate change or did it take time?
Thanks
My EF went from 20% to 39% immediately and feel great.
How many months on enestro George thanks nick
Ejection Fraction 
Does anyone know the ejection fraction average by ages 
Ejection fraction 38
Dilated Cardiomyopathy 15-25% ejection fraction
Ejection fraction low 
