Followup on My Dad

My Dad, 88 y/o, 15 years post-bypass, with an implanated pacemaker to address atrial fib ... has CHF with a 35% LVEF (per echocardiagram). Tricuspid regurgitation (moderate to severe) confirmed by echo. Mitral regurgitation mild to moderate. He is on two diuretic meds (including a potassium-sparing one Spironolactone) and Tenormin. He is still relatively active and in decent shape. The 35% LVEF echo was performed just prior to commencement of diuretic treatments.

His pacemaker battery is just about to expire, and in order to determine whether to replace with a new pacemaker or with an ICD, his cardiologist ordered a Nuclear Stress Test (non-exercise) and a Doppler Echo. The Stress Test (this week) showed a LVEF of 58%. When the doctor saw these results, he immediately ordered a replacement of the pacemaker as opposed to ICD implantation.

So here's my question. We'll find out next week from his echo the degree of his Tricuspid Regurgitation as compared to the last echo. But I was surprised to see a 58% LVEF. Is this from the diuretic meds? Or is his heart actually pumping stronger now than it was prior to commencement of diuretic treatment? And how does this affect his prognosis?

Thanks again for your help!

[Cleveland Clinic]

No it is unlikely that the diuretics have improved his ejection fraction. More likely is that he is not in atrial fibrillation so his EF was better assessed with the nuclear than with the echocardiogram. In our practice, however, echocardiogram is a far better assessment of ejection fraction than the nuclear scan, as slight change int he program parameters can yield markedly different results, and the spacial resolution of the nuclear scan is less than that of the echocardiogram.
Another possibility is that the pacemaker being at ERI is not pacing him as frequently and in his native rhythm his ejection fraction improves. We have seen this with patients with decreased EFs, who develop CHF after being paced.
Tricuspid regurgitation usually affects the right side of the heart and has almost no bearing on someone's ejection fraction, but can sometimes contribute to right heart failure.