Ejection Fraction on Stress Test Low ? 49%

[Michaelccc]

Hi Dr..  I'm a 35 almost 36 year old white male. 5'6 162 pounds. slightly overweight. No drinking , no alcohol. But smoke  heavily. Pack a day for 15 years cholesterol 179 (6 months ago 231) triglycerides 177 (6 months ago 216) hdl 91 (6 months ago 38) ldl 53 (6 months ago 150) .  HS-CR Protein test from 1 month ago 4.0 (my Doc did not seem at all concerned with that finding) .  Blood Pressure Varies from mid 130's systolic  to high 80's diastolic or even sometimes low 90's diastolic to 120's systolic and high 70's at times when i'm calm (which is very seldom since i'm a very high strung person) . 1st Echocardiogram performed 6/7/2007 showed Ejection Fraction of 60% .  Then 2 months later another Echocardiogram performed on 8/15/2007 stated ejection fraction of 55 %.  Now the most recent test which was a cardiolite stress test stated the following. "patient achieved 85% of target heart rate. No Areas of decreased perfusion identified. Calculated ejection fraction 49 % .  Impression : No evidence of ischemia or infarction. Calculated ejection fraction is 49% .         Now here is my question it seems like the ejection fraction first dropped with the consecutive echo studies done last year 2 months apart at 2 different facilities. and now seems to have dropped even further according to the stress test.

1. Which one of these studies should i rely on? the echos done 10 months ago or the stress test ?  
2. Does 49% percent indicate cardiomyphathy?
3. Is this 49% percent EJ the reason for my possibly high diastolic readings?
4. Am i in the beginning stages of heart failure?
5. Can i improve my EF?

  i'm extremely worried and cannot get an appointment with the cardiologist for a month . thank you in advance for your help.                Michael

[ed34]

Nothing to worry about, the Catheterization is simply far more accurate. The echo is good for looking at dimensions and wall thickness's etc, as for calculating EF, it leaves a lot to be desired most of the time.

[VKDSTAR]

Initial reports of echo.
Lvef=49 % mild global hypokinseia
trivial MR trivial TR
no PE,CLOTS
Normal chambers size

Catherization reports are small

After six months echo reports are
lvef=75%
no tr mr
no hypokinseia
nothing...

why is there sudden change anything to worry?

my age is 20...65 kg weight height 5'8'

[Momto3]

Ah yes, time to calm down a bit.  : )

I understand the cancer scare.  Been there, done that.  It is stressful and can make your mind wander.  But, once the tests are done and the doctor determines there is not a problem, you need to focus on living and moving forward.  You are very fortunate to have a healthy heart -- you just need to take care of it : )   (smoking, excercise, diet, etc)

[Michaelccc]

hi. yeah maybe i guess i'm freaking out again.  its just that i won't see my cardio for a month to get official results from him on the stress test and i was wondering why i got the subpar EF readings. i know its not a horrible number but just hoping that its not gonna get worse. know what i mean. also the reason i thought that high diastolic readings may be due to ef fraction is because . if ef readings may be caused by hytrophied left ventricle then that would mean that it would most likely produce high diastolic readings right ? also Connie just wanna let you know went through some family cancer scare and it got me all panicky and stuff , just wanna make sure my health is ok. thats why all the questions

[anacyde]

Find out what your fractional shortening and LV size are.  Fractional shortening is another measure of how well your heart is pumping.  Greater than 30% is normal, less than 30% would indicate dysfunction.  The size of your LV (left ventricle) is very important.  As previously stated, 49% isn't enough for a diagnosis of cardiomyopathy, but I would think it warrants watching.  Cardiomyopathy is considered when you are at 45% or less.  Just take good care of yourself, follow up regularly and make sure you're asking questions at your appointments.  If you're uncomfortable with one opinion, seek another medical opinion as well.

It sounds very likely that you can just be within the margin of error on these readings.  Different tests can yield different results with different technicians too.  All of yours sound within normal limits though.  Hope this helps :)

[Momto3]

Michael,

You say you are "extremely worried" but the doctors have told you, and we have told you on many occsions that you are fine.  The single most important thing you CAN do for yourself is quit smoking.  

"My Doc did not seem at all concerned with that finding."  - That's the opinion of an expert.

Echocardiogram numbers can vary with technicians, doctors, machines....Echo reports will indicate that the numbers can vary by 5-10%.  The difference between 55 and 60 is insignificant.  As for the recent cardolite stress test:  "Impression : No evidence of ischemia or infarction. Calculated ejection fraction is 49% .   Different machine, different tech, different anything can alter the numbers.  The doctor reviewed the tests and determined you are fine.

1. Which one of these studies should i rely on? the echos done 10 months ago or the stress test?  Any of them....they're fine
  
2. Does 49% percent indicate cardiomyphathy?   No, CM is not diagnosed by one number.

3. Is this 49% percent EJ the reason for my possibly high diastolic readings?  Why would that be the case?

4. Am i in the beginning stages of heart failure?   NO!

5. Can i improve my EF?   Quit smoking and exercise.  I do not understand why you do not trust your doctors.

[kenkeith]

The EF is one factor that maintains a balance of blood flow between left and right sides of the heart.  Cardiac output is a function of stroke/volume for 1 minute. Pressure expands the left ventricle and increases preload (filling) .  An increased preload increases stroke volume through the Frank Starling mechanism and that would be an increase in EF.  Frank Starling mechanism can be campared to a hand spring as an analogy.  If the hand spring is slightly stretched the recoil is stronger, but if over stretched the hand spring loses its elasticiy as does an overly dilated left ventricle.

Normal EF range is between 50-75% and fluctuates dynamically as does heart rate, respiratation, system blood pressures, intracardiac pressures are all factors that influence the EF at any given time.

Exercise can increase the EF, slow the heart rate at rest, improve respiration, etc.  With exercise the heart left ventricle increases in size (but not pathologically).  So stroke volume is increased with fewer heart beats.

EF 49% is not evidencce of cardiomyopathy.  And not in the beginning stage with just the consideration of the 49% EF.  Also an EF is an estimate and is within the margin of error to be in the normal range.

High diastolic is an increase in pressure during the heart's filling phase, and should not be of any concern is not evidence of weaker than normal EF pathology.