ejection fraction

[loree147]

Does anyone know if an ejection fraction of 82% can be normal? My echo report showed a pulmonary pressure of 45 which has been the same for the last two years and an e/e ratio of between 11 and 15 which it said was in the grey zone. Otherwise everything else seemed normal.

[sjlrk]

I have skipped heartbeats frequently, I have had an echocardiogram today with everything normal and an ejection fraction value of 72%. Kindly guide me ,is it normal or not?

Pl. reply soon.

Shahjahan Larik
Pakistan

[sjlrk]

I have skipped heartbeats frequently, I have had an echocardiogram today with everything normal and an ejection fraction value of 72%. Kindly guide me ,is it normal or not?

Pl. reply soon.

Shahjahan Larik
Pakistan

[ed34]

If 50-75% is normal, why would the technician write anything above 75% or below 50% unless they were absolutely sure, and it would warrant further investigation.
Calculating EF is the easy part, but if they have the incorrect SV and EDV then the EF is meaningless.

[kenkeith]

Now, right on ed, the idea that you expressed some exact figure on your previous post saying there are different range parameters only means there is a margin of error plus or minus  of 5-10%. But I don't know of any studies that the EF is commonly overstated!  Do you?  Gee should we all consider our EF is overstated?  

I have read many posts from concerned posters were a cath EF that is significantly different than an echo EF.  My EF was 29% with an echo when I was admitted to the hospital for chf, and the cath a few hours later stated an EF over 19%?!  Both figures are close if on considers a margin of error...plus for the cath and minus for the echo, and consider the EF is not a static parameter...it varies just as much as blood pressure!  Also, I was told by a professional that 19% is inaccurate (I inquired) because I would not have been able to walk into the ER or climb any stairs.  

Q jon: I know on my last one my EF% was calculated at 78% but the doctor that did the report called it 55-60% and normal. Again, this is very typical.

>>>>>Where does the information originate that such a variance is typical? That is 30%variance and I don't believe that is typical...but it is good for a laugh :) Think about it, ed if that were the situation an EF calculation is diagnostically worthless, not relied on by insurance underwriters, medical provider vulnerable for law suit, etc.

I provide a following study that relies on a visual view the EF for an estimate is as good as an echo, and I don't disagree with the results.  If you have seen your heart pump on a echo monitor it is very easy to estimate percent just based on viewing the dilated size and after contraction size...also fractional shortening is easy to estimate and be within a 5-10% margin of error (up or down).

....The study.  "Eyeballing ejection fraction correlated closely with all formal methods and the correlation coefficient improved with the reliability of the formal method. This finding is in concordance with prior studies, indicating that eyeballing ejection fraction may be the most accurate echocardiographic method for the assessment of left ventricular systolic function. Since it is readily and quickly performed, eyeballing ejection fraction could be used for routine echocardiography instead of formal methods".

Do you know how EF is calculated?

[ed34]

I agree.

A nurse I know in thallium testing said that the EF is very commonly overstated in women who are small framed. This is very well documented.

[kenkeith]

Maybe further explanation: I agree with the nurse who said  the EF over 80 is the heart compensating for something and that is NOT abnormal!  It is true EF is an estimate, but it is also a snapshot of a cardiovascular system with the interactive simulation of hemodynamics (heart rate, blood pressure, blood volume, etc.).  There almost always is a change in the dynamics (effecting EF, HR, BP, etc) even when a person is at rest so as to maintain the equilibrium of blood flow between the right and left side of the heart with the cardiac output (amount of blood pumped each minute.. .variable) into the system that has parasympathetic and sympathetic implications as well as the structual demands.  

In other words the approx. 82% EF is not abnormal if it is compensating to maintain equilibrium of blood flow of R & L sides.  To be a problem the high EF would have to be sustained for period of time overcompensating to cause the LV to dilate pathologically, etc..The LV is not dilated!  Nor is there any indication of abnormal diastolic function other than E/E' that has not been considered a medical problem.

Loree, do you have your HR and BP at the time of the snapshot of the EF...I assume the doctor has taken that into consideration for a dx. There is a grey area with E/E' 11-15 that may cause the heart hemodynamics to compensate for the marginal chamber pressure...According to the report that is not an issue but it can normally change the dynamics to compensate...IMHO.

I really didn't want to open a can of worms, but estimates do have some validity especially when viewed in a context of a medical workup.

[erijon]

You are correct, it is confusing. A normal EF% is 50-75% and your number is high at 82%, however, my wife just had a thallium stress test a couple weeks ago and her EF came back at 83%. I asked the cardiologist about this when we were going over her results and he said it was fine, these are typically just an estimate and tend to be overstated. He was very pleased with hers. I know on my last one my EF% was calculated at 78% but the doctor that did the report called it 55-60% and normal. Again, this is very typical. If you did not have any other indications of CAD and a normal echo, an EF% of 82 is just fine, especially if your doctor was not concerned.

Hope this helps,

Jon

[loree147]

Thanks Ken for the comments. It is all so confusing. I have had shortness of breath and a dry cough for a few years now and they can't figure it out. A couple of years ago I had pulmonary hypertension ruled out by right heart catheterization. They continue to monitor me with echo's. They all say I have a hyperdynamic heart and my EF is usually above 80. I don't have LVH. This latest echo was the first to mention the higher E/E ratio so I was concerned. The doc who read the echo said that on the apical view, the function was good but I still wonder. A cardiac nurse told me that with a EF over 80, my heart must be compensating for something. I am glad you explained HCM because when you google "high EF", HCM comes up and it was scary!

[kenkeith]

Q: normal LVEF is anywhere between 55-70% or some specialists say 50-75%. I think 82% is a bit high and my worry is HCM (Hypertrophic cardiomyopathy).

It is not quite true and no need to worry about HCM. It is true HCM is a condition of abnormal wall thickness of the heart. But sometimes one may confuse dilated left ventricle (thin wall) from HCM (thick wall).  Dilated LV (thin wall) increases contractility (higher EF), but will quickly or can quickly drop to heart failure range (below 30%) by overcompensating  if the underlying cause is pathological and not corrected. HCM would as a problem will reduce the EF due to reduced contractility of thicked walls...more importantly HCM reduces filling capacity due to inability to relax.:) This condition will cause diastolic dysfunction, ed34 diastolic dysfunction is impaired filling capacity, and systolic is the pumping function and involves the heart's ability to contract...not say a thickened heart wall can contract normally but sometimes there is preservation of the EF with DD (at least for a short term).

As stated dilated left ventricle increases contractility (review and google Frank/Starling phenomonon).  An echo would show a dilated LV if serious, if not serious the heart is compensating and LV would not be dilated abnormally.

There is no precision in establishing a range for the EF because it is an estimate with probably a margin of error of 5-10% and the ejection fraction is not a static parameter.  It is not unlike the heart rate to be be higher than normal for a short period of time...the outer parameters that include a margin of error is probably 50 to 75% whatever.

Thanks for your comments. Take care,

Ken

[ed34]

normal LVEF is anywhere between 55-70% or some specialists say 50-75%. I think 82% is a bit high and my worry is HCM (Hypertrophic cardiomyopathy). This is where the heart muscle thickens. I think it would be wise to ask your cardiologist a. does he feel the 82% is accurate enough to warrant concern, and b. does he feel HCM could be an issue. I assume you recently had an echo and this will give the wall thickness.

[kenkeith]

The ejection fraction is normally at about 70-80% and indicates the percentage of blood pumped with each heartbeat.  The EF is not a static parameter, but fluctuates minute to minute to help maintain a balance of blood flow between the right an left sides of the heart. The EF will compensate with a higher than normal when other factors that help provide equilibrium may be under pressure.  The dilation of the left venticle increases EF, and visa versa decrease EF.  Other compensating factors are blood pressure, heart rate and blood volume, etc.

E/e′ ratio >15 to an abnormality to left ventricle filling pressures and that has an impact on the volume of blood pumped with each heartbeat. The increased EF pumps out a larger than normal percent of blood pumped with each heartbeat. BUT the percentage is of a reduced capacity due to the pressures lowering filling capacity and this helps maintain a balance of blood flow.  If the underlying cause is not corrected the heart will continue to dilate (high EF) but the result will be decompensation as the heart cannot continue to enlarge and LV will lose its contractility and the heart will fail to meet the oxygenated blood demand by the system.  

Pulmonary hypertension is a complex problem characterized by nonspecific signs and symptoms and having multiple potential causes. It may be defined as a pulmonary artery systolic pressure greater than 30 mm Hg or a pulmonary artery mean pressure greater than 20 mm Hg.....   http://www.medhelp.org/posts/Heart-Disease/Pulmonary-Pressure/show/251837

Hope this provides a perspective.  Thanks for sharing and if you have any further questions or comments you are welcome to respond.  Take care,

Ken.