Lower EF and increased LV size after OHS and AVR

[T in YVR]

Hi,

I just had an echo done this week and my Ejection Fraction was sitting at 55%. Pre surgery (last year) it was measured 2x over a 6 month period at 60% EF. Here are the #'s:

Jan/13 - 60% (pre op)
June/13 - 60% (pre op)
Nov/13 - 55% (post op)
Nov/13 - 55% (post op/different hospital)
Feb/14 - 55% (post op)

So, it appears to be down after OHS/AVR...I know its still early days - and I am also on a beta blocker and ACE Inhibitor. Just wondering if anyone else experienced something like this and whether its something to be concerned about longer term - to be at only 55% EF at a relatively younger age (I'm 47). 55% EF is barely on the low end of normal. Not sure if the 2 drugs mentioned above impact the EF (I don't think so, but am not sure).

Oddly enough, my LV size has varied post op as well (normal size is <57 mm)

- 65 mm in Jan/13 (pre op)
- 62 mm in June/13 (pre op)
- 67 mm on Nov/13 (post op)
- 57 mm on Nov/13 (post op/different hospital)
- 62 mm on Feb/14 (post op)

I know you can get differences with the tech/equipment and interpretation of results. Still seems weird that they would have a 5 mm increase in my LV in 3 months time - especially since I am on a beta blocker and ACE Inhibitor. That's supposed to help it go down...Is it normal to have fluctuations like this post op? The surgeon said it can take up to a year post op to see where it will end up. Maybe I need to be a 'patient patient'.

Would be interested in anyone else's experiences or insight. I see my Cardiologist later this week for follow up.

Thanks,
T

 

[Duffey]

I think it's all attributable to your heart's healing. A 5% decrease in EF isn't much, and it might not be accurate. I'd look at results 3 months, six months and a year out for valid comparisons.

 

[clay_from_nj]

I don't think the 5% variance in EF is significant, and I agree with my cardio (and others) that the LV size is a better indicator.

My numbers so far (another coming the beginning of April):

	LVEDV	LVESV	SV	EF
July 2012	246cc	152cc	94cc	38.2%
September AVR	***	***
October 2012	200cc	127cc	73cc	36.5%
March 2013	187cc	100cc	87cc	46.5%
April 2014	?	?	?	?

As you can see, my numbers dropped at first, then got a lot better. I wouldn't declare any kind of trend without some more data first. In my case, I expect the next measurements to be very good. Oh, and I've been on a beta blocker and ACE inhibitor this whole time. Finally, influencing my numbers: before surgery, I was 40 pounds overweight, smoked a pack or two per week, and didn't eat very well; after surgery, haven't smoked anything at all, lost 40 pounds, eat much better, and work out five days a week.

BTW - My cardio gave me EF numbers like "about 30 or 40". He did give me specific LV volume numbers, from which one can easily calculate the stroke volume and EF. The other trend of note is that my diastolic pressure, which was very low, 50ish, is now near 70.

 

[epstns]

T - If you discount the post-op LV measurement of 57 mm, then the progression of LV size makes perfect sense. Since that measurement was at a different facility with a different tech, I would exclude it from any trend analysis. The other measurements all look like things are going in the right direction.

I agree that a 5% change in EF is insignificant. I would just watch for trends as time goes on.