Pediatric Heart Expert Forum
Is a 49% ejection fraction normal for a 12 year old girl?
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Is a 49% ejection fraction normal for a 12 year old girl?

There is a history of cardiomyopathy in my family.  I had my children receive a 2-D echocardiogram so we have a base-line result incase of any future concerns.  My 12 year old has an ejction fraction of 49%.  The cardiologist said the results are normal.  Is 49% for a 12 year old normal?  I think that seems pretty low.  Is there anything I can do with her to increase that number to ensure a better heart healthy future?
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Dear Sjmslp,

I can’t say for sure what the risk is for your children to develop cardiomyopathy.  It depends on several things.  First, it depends on what kind of cardiomyopathy it is, and there are numerous types.  The most common cardiomyopathy is ischemic, which is an acquired cardiomyopathy.  The familial cardiomyopathies include hypertrophic, dilated, and restrictive, as well as a couple others.  In these we are typically most concerned when there is a first-degree relative involved, and I don’t know if you have a first-degree relative involved (this would be a parent, sibling, or child).

An ejection fraction is a three-dimensional method of measurement.  In pediatrics, we actually use a shortening fraction, which we find to be more accurate in our patient population.  In inexperienced hands, measurement of an ejection fraction by echocardiography is often full of errors.  An ejection fraction of 49% is just at the edge of normal, with normal being approximately 50-65%, but again that assumes correct measurement.

At this point, the more important thing to do is not to get an echocardiogram but to have the risk to your children assessed.  First, find out what kind of cardiomyopathy it is.  If it is familial cardiomyopathy but if you personally do not have a first degree relative who has a familial cardiomyopathy, your risk (and theirs) is probably either zero or quite low.  If there is a first-degree relative and it is familial, I would strongly consider having the folks who have the cardiomyopathy undergo genetic testing (although this is probably less feasible with dilated cardiomyopathy).  If they are positive for a gene mutation, then their first-degree relatives (including you) can be tested.  If you are positive, then your children can be tested.  If you are negative, they have no increased risk.

In the meantime, a heart-healthy future is something we probably all know anyway:  appropriate activity and dietary intake.  Activity includes adequate daily exercise for at least 60 minutes and limited sedentary time to 2 hours per day.  Appropriate dietary intake includes limited fast food, fried foods, fatty foods, and sodas; plenty of fruits and vegetables; decreased dairy fat to skim or fat-free; using baking, broiling, or steaming for cooking, and appropriate portion sizes (the size of the palm of your child’s hand).
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Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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