Confusing ejection fraction

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alex1307

Dear All,

Recently I tried to understand what a normal mitral valve ejection fraction should be - the internet sources say that is >55%. But my doctor gave me results of my echo, and I've found this line -

EF (Teich) 67.4%

Why I am told that my regurgitation is severe (4+)? It's better than normal, right?

I'd appreciate any comments,
Alex
 
YOUR EF IS GOOD RIGHT NOW. THEY USUALLY LIKE TO PERFORN SURGERY BEFORE YOUR EF % GOES UNDER 50%. 3 YEARS AGO MY EF% WAS 68%. WHEN I WENT INTO SURGERY 3 WEEKS AGO MY EF% WAS 52%. I WAS ALWAYS TOLD THAT I HAD MODERATE TO SEVERE REGURG. WHEN THEY DID MY CARDIAC CATHERIZATION I WAS TOLD THAT IT WAS 4+. PEOPLE CAN FUNCTION WITH A 4+ REGURG.. THE TRICK IS DO STRETCH OUT SURGERY AS LONG AS POSSIBLE WITHOUT CAUSING ANY DAMAGE TO THE HEART. THATS WHY IDEALLY THE DOCS WON'T RECOMMEND SURGERY UNTIL YOUR EF GETS INTO THE LOW 50'S. THE VALVE PROBLEM CAN LINGER FOR MANY YEARS AND THEN ALL OF A SUDDEN IT CAN GET WORSE VERY RAPIDLY. I FELT FINE UNTIL OCT. 02. THEN I WENT TO GET CHECKED OUT AND WAS TOLD THAT MY CONDITION HAD WORSEN. SURGERY WAS RECOMMENDED ON DEC. 6. THE LAST MONTH I BARELY HAD ANY ENERGY TO DO ANYTHING. LISTEN TO YOUR DOCS AND WHEN THEY SAY IT IS TIME FOR SURGEON GET A SECOND OPINION VERY QUICKLY AND HAVE THE SURGERY DONE AS SOON AS POSSIBLE. WAITING AROUND THREE TO SIX MONTHS CAN DO MORE HARM THEN GOOD. AT THAT POINT SURGERY WILL HAVE TO BE PERFORMED AND THE LONGER YOU WAIT THE MORE DAMAGE YOU COULD DO TO YOUR HEART.




RICH
 
Hi Alex

Hi Alex

It is definitely confusing. My EF is 81 and I have 44% (Singh) mitral valve leakaged. I am anxious to learn more also so glad you asked the question.

Good luck
 
So, if not ejection fraction, then what? Does anybody know about any numerical parameters in the echo report that can be used to estimate the amount of regurgitation?

Or it's only cath which can produce a clear picture? By the way, they are going to cath me a day before the surgery..... Of course, they promised that they will let me go home, if cath is good :)

Thanks,
Alex
 
Not much help

Not much help

here but when my Dr was looking at my Echo results from the Cardio Doc. He said my mitral regurgitation was 2-3 and labled that as severe. So I would imagine your 4+ is surgery level or the highest.

Just guessing here and wishing you the best. Please let us know how your cath is? I will be really curious on what it is like in case my Cardio Doc has me do one.

Good luck prayers and good wishes to you.
 
alex1307

alex1307

Read over Richie rich's response.

I had 4+ severe regurgitation for over 8 years, but my EF% was high, meaning my heart muscle wall was still strong, and I was asymptomatic.
I was monitored every 3 to 6 months, when I started having symptoms I was set up for my 3rd cath, surgery was recommended at that time, my EF% also took a nose dive.

I was told after my 2nd cath, that you take on a whole new set of problems after surgery, so as long as I was asymptomatic, monitored closely and able to work F/T in the Nursing profession, I would be okay, I managed to put all three of my children through college (which was my wish) and then I'd be ready for surgery, I graduated my last in May surgery was in October.

And YES, I do have a whole new set of problems!!!

Terry40
 
Interesting paper

Interesting paper

I've just came across a paper:

http://www.irishheart.ie/PRO/heartwise/2000/Summer 2000/22000C.pdf

From this paper:

"Clinically, loss of contractile function is extremely difficult to measure with any precision as mitral regurgitation enhances left ventricular emptying by reducing the impedance to ventricular emptying. Almost half the regurgitant volume is ejected into the left atrium before the aortic valve opens. Hence usual parameters such as ejection fraction and end diastolic dimension become difficult to interpret.The left ventricular volume overload and the low impedance during systole may give a large ejection fraction (usual normal 58-74%) and less than 60% may indicate dysfunction. Likewise, other parameters of left ventricular function such as end diastolic dimensions and fractional circumferential fibre shortening can be normal even with severely depressed left ventricular systolic function. Left ventricular
end systolic diameter as measured at echocardiography is awidely employed surrogate that reflects changes in systolic function. It is independent of preload and varies directly and linearly with afterload. Therefore, the larger this dimension the worse is the systolic function and it has proven to be very useful in mitral regurgitation as a predictor of left ventricular function. Values greater than 5.0cms are associated with poor operative outcome and values less than 4.0cms have excellent postoperative outcome." [end of the quote]

If to translate this to a normal language - they can't accurately measure EF for a heart with leaking mitral valve.

What do you think, am I right?
Alex
 
Good question

Good question

Alex

For instance I had an echo on 26 Dec and my EF was 64% and then on 2 Jan it was 81%. I also noted that the Echo on the 2nd of Jan the technician pressed really hard to the point of pain.

Maybe one of the more knowledgeable members here can answer that.
 
GIina M (MUGA scan)

GIina M (MUGA scan)

Gina M,

Thank you for your posting about MUGA scan - I'll ask my doctor aboit it. I need these more reliable numbers badly.

Best wishes
Alex
 
simply put

simply put

your hearts valve may be leaking badly but contracting well. Oh yea my ef is currently 31% relax. One other thing the ef is one number the % of leaking is another.
 
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