Accuracy

[Pam]

A reply on this forum said an echo cannot overestimate the degree of valve regurgitation.  Is this true?  My echo showed mild mitral, mild aortic, and trace tricuspid regurgitation. I take toprol (I think to slow my heart rate) and triam/hctz for swelling.  I have shortness of breath, feet and ankle swelling, and fatigue.  My cardiologist doesn't feel the above degrees of regurgitation would cause these. I'm having a heart cath tomorrow to rule out PPH.  I'm wondering is it possible my echo underestimated (or overestimated) the level of regurgitation.  I'd much rather have worse regurgitation than PPH.  Pam

[Cleveland Clinic, MD]

Dear Pam,

Yes and no.  In general echo does not underestimate valvular regurgitation but in some cases it may.  If there not a good image, for example in someone who is very heavy or has poor echo images, then the regurgitation may be underestimated.  Sometimes in these circumstances the doctor will perform a transesophageal echocardiogram (TEE) which is almost always accurate.  For the most part however echo accurately accesses the degree of regurgitation.

[garyr]

Not all TEE's are administered when "out".  Steve Goldberger
describes it, when he got it with a local, far better than I can and it is brutal.

See his Chronicle on the 'Cachnet' website.  If you need the URL
let me know.

Whether Catheter is better or TEE, the advantage of the Catheter is that they can assess the status of the CAs at the same time they measure the leakage in the valves. That advantage comes with the risk of any arterial invasive procedure: knocking something loose with predicatable consequences.

[Pam]

I had the cath and the pulmonary atery pressure was 21 at rest.  The doctor told my husband I do not have PPH.  I was very relieved.  Is the 21 good?  It is something that needs to be checked periodically?  One more question - Before having the cath the doctor said I have 1+ leg pulses.  He asked if I had leg pain.  When I said all the time, he suggested I have it looked into.  I was told that a person my age (40) should have strong pulses in their feet.  What does 1+ mean?  Is this something the cardiologist checks out?  If not what type of doctor should I see?  I was a little out of it.  Pam

[garyr]

A heart cath is going to provide them with more conclusive evidence of the valve regurg than an echo. Considering that they usually give a range for a leak (mine for instance, was 3 to 4+;
that's a 25% variation in and of itself!) it could very well overestimate and underestimate the leakage.

When my cardiologist was not satisfied with the readings he got on my echo and then stress echo (which mimicked a biscuspid valve), he ordered the cath and that led to AVR within 9 months(the cath showed a a Left Ventricular wall contractility that was less than normal, confirmed the 3-4+ leak, and the bicuspid functioning  and some calcification of the Aortic Valve).

The other test they could use is the TEE, a very uncomfortable, to say the least, experience if you are not 'out' for it. But it will provide good information without invading the circulatory system.

[Pam]

Thank you all for your comments.  I think I miss addressed an email.  I thought Terry wrote the first comment, but I think it was someone else named Pam.  Please forgive me.  Did anyone of you read the post I was referring too?  It was a comment from "echo tech" to a post made by a different Pam dated 4/27/00.  I was wondering if it was correct.  Thank you Pam

[MelissaA]

I have some reguritation, and I have borderline Pulmonary Hypertesnion.  The echo said my pressure in the pulmonary was lower than what the Cardiac Cath showed.  How old are you if I may ask?

You can e-mail me at ***@**** If you want to compare stuff.

[Terry]

Just FYI, I've had 2 TEEs and did not find them uncomfortable at all. I think its standard procedure to be "out". The worst part is the yucky tasting stuff they spray in your throat, then a little sleepy-time in your IV. Viola! It's done. I don't know how uncomfortable a cath is but a TEE has got to be less invasive. The results are just as or more reliable than a cardiac cath aren't they?