help me understand test results?

[river-wear]

Hi,

I finally got some of my echo results from my former cardiologist. I asked for everything they had and got three years. Sigh. Probably doesn't matter anyway, huh? Funny how relatively little things can be so upsetting when your health is involved.

Anyway, even though these are older results from 10/06 (haven't rounded up the 2008 & 2009 records yet), I was hoping you kind folks could help me figure out what numbers I should be looking at. Oh, and one other surprise - my AV is "probably bicuspid." 38 years and never once did I hear a doctor say that (although I guess I wouldn't have understood in the first ten or so).

The echo reports have long lists of statistics under the headings 2D, M-Mode and Doppler. Two items the doctor had a note next to were L VIDd (6.21cm) and L VIDs (4.10cm). I see what looks like ejection fraction (61.9%).

The summary says the regurgitant volume is 122ml and effective regurgitant orifice of 47mm2. One other comment has me wondering: "The aortic valve is mildly sclerosed but appears unrestricted to leaflet excursion with eccentric leaflet closure and is probably bicuspid. There is diastolic fluttering of the anterior mitral valve leaflet. The anterior mitral valve leaflet is thickened and redundant with evidence for mild prolapse due to the aortic insufficiency jet."

Thoughts? Are there other numbers I should be looking for when I get my newer results? The 2006 report says the aortic insufficiency increased but my doctor never said there was any change, and the "new" doctor hasn't seen any of my history even though I asked them to get my records transferred over a year ago. I'm considering getting the new test results and starting over with another doctor that (hopefully) I can trust. I'm really, really missing my old doc in Michigan now!

Michele

 

[Nupur]

Hi Michele,

I am assuming LVIDd and LVIDs are the left ventricle diastolic and systolic dimensions. Just as a comparison, my numbers last year were as follows

LVEDD 4.9
LVESD 3.0

I was told by Dr. Miller that the LVEDS is the number he looks for since that's when the heart is squeezing the hardest, and if it is more than 4 cm, that is one criteria that indicates that the heart may be getting enlarged. What are the numbers in 2008 and 2009? I was told that minor variations are ok between tests.

I didn't get an ejection fraction from my cardio. I was told only teaching hospitals measure that, so I can't compare. I guess you have some prolapse of the mitral as well but I am guessing not very serious, from what they say in the report. Mine says
"Mitral Valve: Mitral valve leaflets are c/w myxomatous degeneration. Thickening and prolapse of predominantly P3 and A3 (lateral scallops) with eccentric MR. No chordal rupture."

Regarding the ratio RVOL and RO, I read papers on what those mean for mitral. Will try to find if it the same for aortic.

I hope that helps. You should really sit down with your cardio and ask for the interpretation and how much they rely on numbers.

Best
Nupur

 

[river-wear]

Thanks, Nupur. Interesting what they told you about EF - this was an echo done in the cardiologist's office, which isn't related to a medical school. The doctor doesn't even have privileges at one.

I'm working on getting the '08 & '09 results. Once again no one showed up at the doc's office today so I couldn't get the request moving along. Hoping to pick them up Friday morning.

Doing some more research online, it appears they also look for changes in %FS (fractional shortening). When it falls, it indicates myocardial failure. The two reports I have show it went down 3% but I don't know if that is measurement variability or a real change. I'll have to get more data points.

 

[jjay32]

rule of thumb on ejection fraction is above 55% is good. My fraction has varied from 58% ti 70% on my last 2 echo's. So your ejection fraction looks good.

 

[river-wear]

I picked up my '08 and '09 records this morning. Here's what I see - at least what highlights I think I should post. There's a lot more data on the paperwork.

..............2006...............2008..................2009
LVIDd:.....6.21cm...........5.7cm.................6.4cm
LVIDs:.....4.10cm...........4.2cm.................4.5cm
EF%........61.9%.............51%...................56%
FS%........34.0%.............27%...................30%
RVSP.......21.8mmHg........25mmHg..............19mmHg

I saw RVSP mentioned in some other posts, but I suppose that's related to mitral valve problems. Anything else I should be looking at? It kind of looks like my current cardio was over-reacting a little when she said I need surgery, or my old one was being too passive by not recommending it.

The reports also say the aortic root is normal size, and all of the other valves (pulmonic, mitral and tricuspid) have trace regurgitation. Looks like my heart came from the "bargain bin."

 

[Lynlw]

Its interesting that many of the 06 and 09 numbers are closer and the middle 08 are different, did you have the 08 and 09 tests done at the same place?

 

[tobagotwo]

The reports also say the aortic root is normal size, and all of the other valves (pulmonic, mitral and tricuspid) have trace regurgitation. Looks like my heart came from the "bargain bin."

This sentence is actually all good news. "Trace" level regurgitation (aka insufficiency) can be found on and off in anyone's heart echo. Nothing bargain basement about it. It means an amount of leakage that is entirely insignificant to the operation of the heart, but which is considered reportable only because the echo was able to detect it. Often, it will even disappear in future echoes.

Your RVSP (Right Ventricular Systolic Pressure) has to do with your right, rather than left ventricle. The left side of your heart feeds oxygenated blood to the head, heart, and body, and the right side feeds used blood through the lungs to renew its oxygen content, and out to the left atrium, where the left side collects it to pump to the body again.

The RVSP can be used to indicate whether you have pulmonary hypertension, although echo results for this are not the most accurate way to tell (right heart catheterization is the gold standard). Your 19 mm Hg reading seems well within range (normal = less than 35 mm Hg).

As far as it having to do with the mitral valve: your mitral valve is in your left heart, so the mitral valve's significance (if any) to the RVSP would be from back pressure from stenosis or regurgitation.

Best wishes,

 

[river-wear]

Thank you, Bob. That makes me feel a little better.

Lyn, both of the '08 & '09 tests were done at the same place. I think it may have been the same technician as well. I noticed the same thing about the results. The 2006 result was from my former doctor's office. The '05 result was pretty consistent with '06.

My current doctor is supposed to review the older tests and call me next week with her opinion on them - whether it changes anything that she told me. I will ask for her recommendations regarding surgeon as well. Depending how well that discussion goes, I will decide whether to take everything to a potential new cardiologist. So far I don't have a lot of confidence in her, and I won't be able to go through this without having full respect for the doctor.

 

[Gail in Ca]

If you make an appt with Dr Miller, he will help you as well. He is conservative and won't recommend surgery until he thinks you need it. That's what I found anyway.

 

[Maryka]

I was trying to wade through all of those numbers of yours and I got lost. I appologize. However, it seems you are going to Stanford. Stanford: I can comment on that!

I worked in CA from mid 2002 to mid 2003. In late 2002 I went to Stanford for my annual heart checks and Dr. Liang was the first professional anywhere to get a good shot of my Aortic Valve on an echo and confirmed that my "maybe bicuspid" valve was really and truly bicuspid. He even showed it to me on his laptop computer. If you are seeing Dr. Miller at Stanford I would trust that his colleague, Dr. Liang, can clarify your situation. (Of course, some connective tissue disorders cause an aortic root aneurysm even without a bicuspid aortic valve. The surgical solutions are almost identical, however, so maybe it does not matter.)