ejection fraction

[James B]

I have seen two cardio doctor's in the past five years. One regular, One for second opinion's. One has had my ejection fraction in the 30-35% range. The other has it at 50%. These are both on echo reports. I've had a previous MI termed as massive. Ejection fraction on stress test after MI 29%, On cath 40%. Why is there so much difference in the numbers. I made a decision on my heart health care a while back based in part on the ejection fraction number.  I used the higher number for my decsion. I've second guessed myself ever since.


                                                   Thanks, James

[CCF-M.D.-RCJ]

James,

Thanks for the post.

Several reasons may explain the differences in ejection fraction (EF) in your case.

(1) EF is estimated visually.  A doctor "eyeballs" the tape/image and then assigns a number for the EF.  Even at large centers with good quality assurance programs, the inter-observer variability (the difference between two doctors) is about 5-10%.  At the Cleveland Clinic, and most other good centers, the EF's are reported as "X" +/- 5%.

(2) Among survivors of MI, the EF is usually at its lowest within the first few days to week after the MI.  From there, it usually improves as the heart remodels and recovers from the stunning imposed by the MI.  So if your first EF was evaluated soon after the MI, it will usually be lower than subsequent EF values.

(3) Miscellaneous causes can lead to better or worse EF on any given day.  High blood pressure, dehydration, faster heart rhythms, etc all can lead to discrepant values.

One suggestion is for you to send the echo tapes to a referral center for evaluation.  Our expert echo sonographers here have a referral number by which this can be accomplished (try www.clevelandclinic.org).  Alternatively, seek a third opinion at a large medical center.

Good luck, and I hope that helps.

[ldybg]

Hi,
    I have an EF at 20%, my heart was damaged and I have been on different meds for 8 months now. I haven't improved any, but I haven't gotten worse either. If I do not improve ever, can I get by with just 20%? I'm only 36yrs old. Kelly