Echo Results and Arrhythmias

[Jeff67]

I am 37 yo male. History of PAC’s, PVC’s, occasional SVT (or NSVT since never captured). I have some questions about past test results that I am hoping you can answer:

In an echo I had 14 years ago some of the findings were:
LVPW = 8mm, IVS = 7mm, FS = 36%
Comments: Mitral valve structurally normal, mild MVP.  

In an echo and stress test I had 7 years ago some of the findings were:
Echo:LVPW = 11mm, IVS = 11mm, EFc = 80%
Comments: Anterior leaflet of mitral valve appears mildly elongated and slightly thickened and there is evidence of minor bowing of the body of the anterior mitral valve leaflet without evidence of MVP, trivial mitral regurgitation.  
Stress:Comments: Achieved 15.5 METS (Bruce Protocol) and resting EKG showed non-specific inferior ST segment and T wave abnormalities, with slightly more prominent upsloping inferior ST segment depression which was not diagnostic.  

I then had an echo and stress echo 3 years ago where some of the findings were:
Echo:LVPW = 9.5mm, IVS = 8.8mm, EF = 51%, FS = 26%
Stress:Comments: Achieved 13 METS, 111% of maximum heart rate (204) and it showed normal wall thickness and motion at rest and after exercise and no new ST segment depression.

Is the variation in wall thicknesses across these tests expected? Why would my EF drop from 80% to 51% over this period?Does an EF of 51% and FS of 26% and my high HR during the stress-echo indicate a weakened heart or does the 13 METS contradict this?  Why might MVP and regurgitation be seen in earlier tests but not in the latest test? My doctor says all is normal.

[Cleveland Clinic]

jeff,

thanks for the post.

The wall thickness is a measurment and is very subject to the technique used in determining where the measurements are taken.  Those measurements are within reasonable range of each other.

13 METS is pretty good conditioning.  The rest of the measurments are what would be expected with exercise.

MVP is often overcalled. More recently, cardiologist are a little more strict on how this is read. Trivial mitral regurgitation is seen frequently.

Your results sound pretty normal.

[tickertock]

Great questions, Glad you got to post your questions. I was diagnosed with mild MVP on echo an over 20 years ago, my last echo in 2001 showed no MVP or leakage whatsoever with an EF of 75%.

My wall thickness in the last echo 2001 was basically the same as yours.Apparently the diagnostic criteria for true MVP has changed over the years and MVP was and still is sometimes overdiagnosed.

Looking forward to the docs reply also. Take care.

[tickertock]

My wall thickness in my last echo 2001 was the same as your echo 7 years ago ,between 9mm and 12mm, basically the upper limits of normal, averaging out at 11mm, borderline LVH.

Always leaves one wondering?? and more ??

[Jeff67]

Thanks for your comments.  So a change in EF from 80% to 51% by echo over these years is not unusual?

[Jeff67]

Thanks.  It did take a while for me to get it posted!

Seems we are quite similar in the numbers.  Based on my first echo I was told by my cardiologist I had thickening of the left ventricle due to high BP and that I needed to be on meds and a special diet for the rest of my life.  I knew I did not have high BP (normally 110/65 on calibrated home monitor) so my regular doctor took me off the BP meds.  Of course, I spent years worrying that if it is not due to BP then it could be CM. I eventually had another echo that showed my measurements as being much more mid-range.  Just goes to show the anxiety a doctor can cause by jumping to conclusions on a test that is known to be quite inaccurate.  

I was really hoping the doctor would address my question about the large drop in my EF over the years as that is the one thing that I do wonder about. I have always done well in terms of the METS I have achieved and I used to run marathons for a number of years, but I have always had a high HR for my age during exercise so I started to wonder whether this was due to my EF being on the low end of normal. Maybe just another gross error or maybe it had something to do with the beta blocker I had started the day before that particular echo.

Take care ...

[Cleveland Clinic]

jeff,

I find nothing to worry about on that echo report. Your EF is in the normal range and your exercise tolerance is good. I have to wonder if the EF of 80% is accurate as that number seems higher than what we generally report and was probably a calculated value. A beta bloicker will decrease the observed contractility, so if it was changed from previously it is probably a combination of the 2.

good luck

[telboy]

Hi All
        I have only just come across this forum and have been reading lots of posts.
  Like a lot of people here I have been suffering from AF for some years now, being treated with Sotalol and Warfarin.
  However I have gradually gone into what is Perm AF, which as I live in Portugal ( I`m actually English and not very well covered medically here) is of some concern to me.
  Due to a change in symptoms recently I had an Echo done down here and while the Cardio`s report suggests no problems other than the AF the lack of real ability to comunicate, left me with the report but no real understanding. I am pretty unfit 56 year old male.
They used a Philips machine and so I think the results are in a format understandable by anyone who understands. So here are a few of the results ( They use cm ,not mm)
RVDd....1.96
IVSd....0.954
LVIDd...5.19
LVPWd...0.848
IVSs....1.48
LVIDs...3.39
LVPWs...1.38
Ao Root Dia.....2.86
ACs.............1.91
LA dimension....3.71

An FE of 35%

Only adverse comment was a Mild Mitral Regurgitation  

I know a diagnosis cannot be given, but does everything look in order with these particular results?
Appreciate any comments.