Ejection Fraction Lowest Ever- I am worried. Please advice

[Tinu1959]

Got my Echo Report today. I got one about a month back and its results were not correlating well with earlier reports. So I decided to get one more by same technesian/cardiologist on same machine. I have compared results of my Echo in April 2008 with the current report and also with echo report one month back. Though I am unable to make out whether the report is accurate, two measurements have disappointed me. My EF has gone down from 30% to 26%. My LV size has increased from 61 mm to 69.5 mm. I was expecting these two parameters to improve with respect to last echo. Is it begining of my end since parameters have started deteriorating even after all efforts. I put lot of efforts to improve my condition, diet, medicines, exercise, yoga and whatever my doctor tells me for last one year after MI. Looks like my condition had been so bad that it is unlikely to get reversed. I am just wondering if one has to die anyway, is it worth following all the advices on medicines, diet, exercise et. etc.??

On the brighter side I may say that I have been feeling more energetic since I have joined yoga classes one month back. I can still walk about 2 km daily(earlier I used to walf 4 kilometers after MI but reduced to keep my heart rate as low as possible) without getting tired and attend my office 10 hrs a day. Even my average pulse rate has come down by 8-10 pulses/min my BP has not increased from 100/70. Than why this deterioration in EF and LV size. Is there any other test except cath. which can give more accurate picture ?? Is there any hope for improvement ?? Please advice. Thanks for your time and attention. Sorry for putting all the information on board.

                16 September, 08             6 August, 08              22 April, 08
Mitral Valve
EF Slope                 110 cm/sec            110 cm/sec              110 cm/sec
DE Amplitude 19.9 mm                             18.7 mm               18.6 mm
EPSS                 20.4 mm                            17.6 mm              14.9 mm
Comments                 EPSS Raised             EPSS Raised              EPSS Raised
Arotic valve/LA
Arotic Root Diameter 29.5 mm                             32.3 mm               29.8 mm
Cusp Separation 19.3 mm                             18.7 mm                18.1 mm
LA size                  46 mm                              38.6 mm                45.2 mm
Comments                 LA Dilated                              AV sclerosis+ LA Dilated
Tricuspid Valve Normal                              Normal                  Normal
Plum Valve Normal                               Normal                   Normal
Left Ventricular
LV Size(diastole) 69.5 mm                               67.6 mm                     61.0 mm
LV Size (systole) 54.2 mm                               57.9 mm                    55.4 mm
LV Volume (diastole) 154 mm                               Not measured 118 mm
LV Volume (systole) 114 mm                               Not measured Not measured
Stroke Volume 42 ml                               56 ml                  39 ml
Heart Rate                  84 bpm                               92 bpm                   85 bpm
Cardiac Output 3.5 Liters/minute               5.2 Liters/minute 3.33 Liters/minute
Ejection Fraction 26%                               30%                  30%
Mitral Valve Flow Velocity
E wave                 108 cm/sec                100 cm/sec 108 cm/sec
A wave                  49 cm/sec                Not measured 34 cm/sec
E:A                   2.19 cm/sec                Not measured 3.15 cm/sec
IVS
IVS (diastole) 6.9 mm                                 5.4 mm                 7.7 mm
IVS (systole) 11.0 mm                                6.0 mm                 9.0 mm
PW
PW (diastole) 6.3 mm                                 8.4 mm                  7.7 mm
PW (systole) 8.7 mm                                 12.1 mm                    8.7 mm
RV Size                   17.2                                 15.7                   15.9
Right Atrium Normal                                 Normal                    Normal
Pericardium Thin                                 Thin                      Thin
Pericardial Effusion Nil                                 Nil                     Nil
Flow Indices
MV Peak Velocity 108 cm/sec                  100 cm/sec 108 cm/sec
AV Peak Velocity 80 cm/sec                           95 cm/sec                   85 cm/sec
TV Peak Velocity 62 cm/sec                                 67 cm/sec                    72 cm/sec
PV Peak Velocity 79 cm/sec                                  81 cm/sec 91 cm/sec
Final Impression (16 September, 08) Large LV with varying degree of hypokinesis of most LV walls with LV apex, anterior and inferior wall being akinetic and posterior IVS best preserved. LVEF=26 %. Moderate MR+. Mild Aortic valve thickening with mild AR seen.

                                 (6 August, 08) Large LV with varying degree of hypokinesis of all LV walls with LV apex, anterior and anteroseptal and inferior. LVEF=30 %. Moderate MR+.

                                  (22 April, 08) LV is enlarged. Varying degree of hypokinesis of most LV walls seen. Lateral wall best preserved. LVEF=30%. Mild MR +. RV Fair

[Tinu1959]

Thanks for the suggestions. I have consulted my doctor for the test. I will go for it sometimes next week. I agree with you that there may not be much difference between 26% EF and 30%. But another parameter, LV size, together with EF indicates that remodelling of my LV still continues after one year of MI despite all precautions.

The continuation of remodelling will, in my opinion, will lead to further reduction in EF. Does anyone know what are the possible options to stop further stretching of LV. I take beta blockers, ACE-I, blood thinning drugs and statins and of course very low fat diet, regular walking and now I have added yoga. My pulse rate at rest is 65-75 bpm and BP is 100/70. What else can be done??

Thanks for any advice I can get from this forum.

[malden2]

From what I uderstand, an echo has a margin of error, and usually, they quote the results in bands of five (e.g. a 26 may be condiered in the 25-30 range). . Therefore, I would think that there is really not much difference between an echo reading of 26 and an echo reading of 30.

If you are really worried, I would ask a doctor if you should have a MUGA which will give a more accurate picture of where your EF is.

I would not worry.