Mike From Michigan
Active member
Here is something I found to be a little disconcerting...
This past January I had a stress echo done with the following results:
Jan 2004
Mean pressure gradient: 50.5 mmHg (pre-test), 67.2 (post-test)
Peak Velocity: 4.2 m/s (pre-test), 4.8 m/s (post-test)
Valve area: 1.0 cm2
Ejection fraction: 55% (both pre/post test)
When my cardiologist reviewed the results he said that all of those measurement were just into the severe aortic stenosis stage and that it might be time to consider surgery, even though I went the full 15 minutes with no symptoms. However, he agreed that it would not hurt to get a 2nd opinion before I made my decision so I went to another cardiologist he recommended, working out of a different hospital, and I had another stress-echo. Here are those results:
April 2004:
Mean pressure gradient: 30 mmHg (pre-test), 58 (post-test)
Peak Velocity: 3.24 m/s (pre-test), 3.8 m/s (post-test)
Valve area: Not measured (Why, I don't know...)
Ejection fraction: 60%
Note that all of the 4/2004 measurements now fall into the "moderate stenosis" category. Now one of 2 things happened in those 3 months - either my condition improved (impossible, as far as I know) or there is a large degree of variability in this test. For example, the pressure gradient measurements varied by 40% between tests - not what I call an exact science!! What scares me is that they are basing their decisions on whether it is time for surgery or not based a lot on these numbers - give me a break! As an engineer I find such test variability as being unacceptable, especially since my life is on the line in a way. Both testing places insist their results are the true results of course, however my 1st cardiologist said that if there is any operator error (and there is plenty of room for that), it would show "better" numbers, as the April numbers. The primary reason would be because the person running the echo machine did not cut good sections he explained..
The other part of the 2 cardio Drs. decision on whether to recommend surgery is my symptoms. Well, truth be told I was mostly symptom free until I was told back in Feb. that "it might be time". Now with this test data confusion I have become somewhat stressed and feel some symptoms sometimes, directly correlated to how much stress I am under thinking about all of this. Somedays I have no symptoms at all (mainly when my mind is clear), other days, doing the same activities, I feel some slight chest pressure, even a little light-headedness if I am really stressed out about this.
What do you guys think of this? My main point is that I never knew that echocardiograms were subject to so much varability. With so much riding on those tests, that is not a comforting finding. I am now stuck in the gray area when I want this to be a "black/white" decision - to cut or not to cut, that is the question...
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