EF Question

[Smitty1956]

Hi, Everyone,

Roughly three weeks after my heart attack in March 2022, I had what is called a nuclear heart stress test. It was a perfusion one-day rest/stress protocol. The isotope used for nuclear imaging was technetium tetrofasmin administered intravenously.

My left ventricular post-stress EF was 73 %. The left ventricular resting EFwas 72%. I am assuming that these percentages were actual measurements obtained during testing. I read that the normal range for women is 54-74%.

Flash forward to August 17, 2023. I just had a trans thoracic echocardiogram performed. The report states that I have a normal left ventricular size. Borderline LVH. Plus, it states that my left ventricular EF by visual assessment is estimated to be 55%.

So, one question is whether I have a more accurate measure of EF taken from the nuclear stress test or from the “eyeball” assessment and estimate of the echocardiogram. Should I feel concerned that my EF appears to have dropped in over a year? Or should I ignore an eyeball assessment and estimate? I feel concerned about the numbers, but also confused. I have made an appointment to talk with the cardiologist in October about this report.

Also, how concerned should I be about borderline LVH? I have read that LVH can be serious. I do have abnormal diastolic function with elevated filling function.

Okay, I know that you cannot provide medical diagnoses or advice, but does anyone have any thoughts on all of this?

I saw the cardiologist and had the echocardiogram in order to learn more about my breathlessness/breathing problems. The cardiologist got this all wrong in his notes and felt that my main concerns were palpitations and some chest pains. I personally had wanted to see a pulmonologist because of the breathing issues—not a cardiologist, but the referral was made to the cardiologist.

[Yumz199725]

Hi smitty1956I wasn't even aware EF could go to 74 as mine has always been 60 something and now it's 59 so has only dropped bout 3% in about 6 years x I hope your cardiologist can help shed some light on why yours has dropped so much in year, and why you have been referd to a cardiologist?? X wish you all the best let us know how you get on.

[Smitty1956 in reply to Yumz199725]

Thank you, Yumz199725,

I think that I am in that super anxiety stage right now. The earliest appointment that I could get with the cardiologist was for the end of October/beginning of November. As we always say, “the waiting can be the hardest part.”

After writing my post, I read a little more about left diastolic functioning on Dr. Google (probably not the best idea), and my concerns have turned to worry about possible heart failure. That could also explain the problems that I am having with breathing.

I was hoping that some others might also respond with some thoughts on all of this. Anyway, thank you for taking your time to respond.

Your EF sounds good and that is excellent that you have maintained that percentage for over six years! We’re you able to get the results from your last procedure/test that you had done in London? I hope that you are getting along well.❤️

[Yumz199725 in reply to Smitty1956]

Ahh hi so sorry I didn't reply had such a busy weekend! 😅. Yeah I'm so terrible for going on Google 😂😂, just designed to scare the crap out of people 😂😂 still find myself doing it, breathlessness can be caused by alot of things, even viteman definces can I found that out. I haven't got my results yet its driving me crazy!! 😩. Still waiting on MRI appointment.

[Hidden]

Hi, I would ask the question of your Cardiologist, but, the view from mine (UK) is that the more accurate measure of EF is taken from the nuclear stress test than an echocardiogram.

In March, my EF was 30% by Echo, and 46% by MRI in July after 2months of meds. As much as I think the meds have made a difference, thats a significant improvement which prompts the question how accurate the echo was, and is making them think again on implanting a CRT. The problem with an echo is that its only as good as the person doing it and is an estimate.

If it is actually down to 55%, you will still be within what is considered normal range, but, certainly worth asking the question why the perceived reduction. As such you wouldn't fit the criteria for Heart Failure with reduced EF (HFrEF), but the borderline LVH could put you in Heart Failure with preserved EF (HFpEF). Again, a question for the Cardio.

[Smitty1956 in reply to Hidden]

Hi, Heedio61,

Your EF percentage did seem to take quite a jump in two months as measured by the MRI results, I think that you mentioned taking new medications for two months prior to the MRI. Do you think that the meds themselves accounted for the increase? I do agree that I suspect that the echocardiogram EF results are not as robust as those from a stress test or MRI, but that is just my thought.

You raised some good questions for me to jot down and take to the cardiologist visit. I have to write it down as the memory isn’t quite as sharp as it used to be. 😃

I suspect (again—I may be watching too many British detective dramas) that you may be right about the HFpEF diagnosis. All of this worries me to death, but, for me, it helps some to begin to wrap my head around this possible diagnosis. Perhaps, I can discuss all of this sensibly with the cardiologist by then instead of falling apart in his office. 😊

I read that LVH is usually defined within four classifications/stages, but I did not read any reference to any specific stage in the report—just the phrase borderline LVH. That phrasing makes me hope that this might be only Stage 1, or possibly, even reversible, but I may be too optimistic.

I thank you for taking your time to respond, and you have given me more for thought. Also, I hope that your EF continues to improve with the new medications that you are taking. Hopefully, your doctors will feel that you don’t need the CRT. ❤️

[Hidden in reply to Smitty1956]

Hi, Over the years I've had Echos' for fun, and for my Valves and Shunt, its the best option. However, for checking EF, I'm of the mind that an Echo has its limitations. Its only as good as the person doing it and how they interpret the results. So, as much as I'd like to say the improvement is down to meds alone, I think its a combination of factors, including interpretation.

Take care

[Elsabounre]

Your echo test results of 55 is quite perfect..between 50 and 65 are considered normal..so it seems the EF is not your main problem..congrats on this good result

[Smitty1956 in reply to Elsabounre]

❤️💕

[iansHealth1]

Hi all

I’m obsessed with my EF as I need a certain number to go back to work (40%), but what I’ve found is that the interpretation of EF results depend on the Dr reading the results.

I’ve had Drs on consecutive days tell me my EF is 17% & 25% from the same echo and x-rays.

I had a cardiac mri t’other week and it gave me 37% EF.

I’m told the machines are more accurate than the human eye.

Who knows…

[Smitty1956 in reply to iansHealth1]

Good information! I think that you are likely right about mechanical measurements being more accurate than the human eye. At least, I would like to think so.

I hope that you can reach that 40% that you need! That would be a positive thing for many reasons. Thanks for replying! ❤️

[Hidden]

The only thing I will add is my experience of Ef. Now the interpretation of ef is to some degree down to who is looking at it and how they measure it. So an echo will not be as accurate as an mri. Admittedly I have never had a nuclear stress test so I carnt comment. However when I had my echo in hospital the ef came out at 40% to 44% estimated when I had my mri a few months later it was 51%. You have to remember the day in hospital was a bit busy as they where trying to find what was wrong with me. But once they knew I was then refured to the congenital team who over a period of months wanted to know the ins and outs of my heart. Now ef can be worked out if you know certain parameters. So these are my parameters and the maths to go with it so my stroke volume is 57ml, my LVEDV (left ventricle end diastolic value) value is 110ml. So you do 57 ÷ 110 = 0.518 × 100 which comes to 51.8 %. Now I have to admit these values came up from my cardiologist using the mri. However in the right hands and experience I assume these can also be found from an echo but I don't really know. The same ejection fraction maths can be done for the right side as this side will have an Ef as well. I know this, as that's where my problem is the right side. And the Ef on the right is for me is 21% the maths is RVEDV 269ml and my stroke volume is 57ml so 57÷259=0.211 × 100 is 21.1%. See every day is a school day.

[Smitty1956 in reply to Hidden]

Hi, Felly12,

That information on the math calculations is very helpful. I did receive tables of letter combinations and measurements, but I don’t see LVEDV listed. I would need that data in order to perform the maths.

For example, I have LVIDd, but I have no idea what it means. I also have LVIDs, but, again, not sure of the meaning. A lot of data is provided, but not a key for interpretation.

I have not had an MRI—yet—but that may be in my future at some point. I would likely guess that my EF is likely somewhere in between the estimated 55% of the echocardiogram and the 72% of the stress perfusion test. I still have major concern about such a major drop in that number over the course of 17 months, but while I generally feel better than after my HA, I notice more difficulty in my breathing.

I guess that after writing my post, reading more, and reading responses to my post, I do suspect that I might have some form of heart failure—not what I want to think—but, perhaps being realistic. I hope that by the beginning of November, I might have some diagnosis, whatever it is, from the cardiologist. Waiting and accepting are just hard.

Thank you for your reply! If I get the needed data, I will definitely do the maths. ❤️

[Noodlesalad]

Found this thread really interesting to read. Everyone on here is a massive help when worried about a test result.Here's my question because I have googled it but it's not very clear.

I have mild CAD and moderate LVH. When I asked my GP about this because he didn't have the full reports on my heart CT or cardiac ultra sound his response was the LVH isn't important.

I would be interested to hear what you all think.

Thank you in advance.

[Smitty1956 in reply to Noodlesalad]

Hi, Noodlesalad,

You are absolutely correct that members on this site are a massive support! I have appreciated hearing thoughts from all who responded to my post. I have more ideas to think on and more questions that I can discuss with my cardiologist,

I don’t know for sure, but from what I read, LVH sounds serious. It also can relate with, or perhaps contribute to, pulmonary issues, heart failure, and more. I would suggest discussing your CAD and mild LVH with your cardiologist. From what I read, LVH also falls into stages of disease progression. Even if you are in Stage 1, you would want to learn how you might slow any progression into Stage 2. I honestly don’t want to scare you, but I would at least discuss this with another doctor.

I also have been diagnosed with CAD, had a HA in 2022, and my echocardiogram states borderline LVH. I do plan on discussing my report in detail with my cardiologist in early November. I know that I am afraid and I do have anxiety, but I also need to know where I stand. Sometimes asking questions and gathering information from others helps me to prepare for data from doctors.

I wish you the best in getting to know what your report(s) tell you. ❤️

[Noodlesalad in reply to Smitty1956]

Hi SmittyThank you so much for taking the time to respond to my question.

After I had the two tests along with wearing a heart monitor for a month, the cardiologist write to my GP and said that my blood pressure and angina should be treated aggressively along with my weight problem.

I have asked the hospital I had the tests done at for copies of the reports and their sending them to me on a disc which means I'll have to go to my local library and use the desk top system there as my laptop doesn't have a disc compartment.

Thank you again.

[Keder]

I was sent the original x-ray consultant's report of my MRI scan post second MCI. Having used Google to interpret it, I became very afraid as I couldn't understand how I was still alive.

EF 15% and lots of LV damage. I'd be very happy with 73%. I've been told that 55% is the average.

Subsequently told to forget the figures and concentrate on how I feel. Also learning to relax (especially chest muscles) is good. Do you think breathing issues might be caused by the stress you're feeling? Everyone has their own way of de-stressing - what's yours?

[Smitty1956 in reply to Keder]

Hi, Keder,

Well, you stopped me in my tracks. 😊 I do have anxiety disorder, and I do feel a lot of stress. Sometimes, I question if some of my breathing problems are related to anxiety, but I honestly think that there is something else going on; however, difficulty breathing makes the anxiety worse. Vicious cycle.

You are correct. I do need to learn better ways to de-stress. I struggle with this, and, as my doctor stated two weeks ago, I will be trying to cope with anxiety for the rest of my life. Although, she did tell me that she thinks that I have improved some over the past year.

I’m really sorry that you are dealing with low EF and LV damage. That can be so hard to read in a report and to accept. It sounds like you are coping well with it all. I hope that your EF does improve and that you can feel even better.

I will think more about your suggestion on finding ways to de-stress. Perhaps that could help me to feel better. Thank you for taking time to respond to my post. ❤️