My husband is 66 years old and suffers from cardiomyopathy. Although his
previously active lifestyle has diminished considerably over the last two years,
with medication he is able to lead a relatively normal and comfortable life, feeling
good most of the time. His ejection fraction has continued to decline over the last
two years and is now at 18. His cardiologist feels it's time for us to visit
with a transplant team, although he doesn't think a heart transplant is called
for just yet.
My question is at what point is a heart transplant necessary? How low can the
ejection fraction get before we must be truly concerned? At 66 years old, is
my husband a viable candidate for a heart transplant? He has always been in
good health otherwise and has no other ailments now. Thank you for your time.
Dear Susan, thank you for your question. The ejection fraction (EF) is a value
measured with an echocardiogram or a catheterization which determines how
efficiently the heart is contracting and ejecting blood. Normally, the EF is
greater than 55%. With cardiomyopathy (a primary disease of the heart muscle),
the EF decreases but at a different pace in each patient. The absolute EF value
is not the determining factor in assessing a patient with a cardiomyopathy however,
because it is a measured value that is subject to a good amount of error and
can't be accurately reproduced. Basically, the heart is traced on still frame
echocardiogram images to determine the EF and depending on who's doing the tracings
and what the quality of the images are, the EF can vary by +/- 15%. Thus, even
though your husband's EF is 18%, he sounds like he's doing well from a functional
standpoint on medications. Indications for a heart transplant primarily are
symptoms and not the EF. We grade the symptoms of heart failure as Class 1-4. Class 1 patients
get fatigued and short of breath with only severe exertion while class 4 patients
are symptomatic at rest without doing anything. Class 2 and 3 describes symptoms
in between. Patients are only considered for heart transplant if they have symptoms
that place them in Class 3 or 4 heart failure. The process of heart transplantation
is long and drawn out due to the limited supply of organs available for transplant.
For a patient to have a reasonable chance of receiving a heart transplant (that
means an average waiting time of 2-6 months), they have to be hospitalized on
a continuous infusion of a powerful medication to improve the heart function or
they have to be supported by a mechanical device (intra-aortic balloon pump
or left ventricular assist device). Thus, as you can see, consideration of heart
transplantion is a serious step and requires great thought by both the doctor
and the physician. At age 66, your husband is near the upper age limits to
be eligible to receive a heart transplant, so you may think that waiting for
another few years may make him ineligible for a transplant. I can't answer the
question of whether now is the time to consider a transplant; that needs to be
answered by your cardiologist with you asking a number of pointed questions regarding
the indications that I've mentioned. However, from what you've told me, it doesn't
seem that your husband is symptomatic enough now to be seriously considered
for a transplant. You also should ask his cardiologist about what his prognosis
will be 5-10 years from now with his cardiomyopathy. I hope you find this
information useful. Please write back if you have anymore questions.
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