Your uncle may have had some heart muscle damage due to a heart attack. Often the heart cells are either non-functioning or have died and can not be revived. Damaged heart cells reduces the heart's ability to adequately pump blood into circulation because the damaged heart cells of the heart wall do not contract strongly.
Reduced contractility will not pump effectively enough to meet the system's demand for blood/oxygen would be worst scenario. To provide an EF calculation the echo estimates the volume of blood pumped with each heartbeat. Your uncle's ejection fraction (EF) is estimated to be at 18% (normal EF is 50 to 70%).
About 7 years ago, I had had a heart attack and the EF was below 29%. With treatment to increase the blood flow to deficit areas caused by occluded coronary, my heart has returned to normal size and my EF is 59%.... Many times one's medical condition can return to near normal with the proper treatment.
Thanks for your question and if you have any further questions or comments you are welcome to respond. Take care and I wish you and your uncle a Happy New year going forward.
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