Ejection Fraction

[josie490]

Hello Doctor,

When I was reading through my medical files, I noticed something that I would like your opinion on.  I had an echo done about a year and a half ago and it said my LV EF was 58% (I was in constant bigemeny of PVC's).  I then had a cardiac MRI in September that showed my LV EF was 52% (I was on sotolol at the time and had no PVC's).  Then a few months ago I had an Ventriculargram and on the report it says the VISUAL ESTIMATE of my LV EF was 40% (I was in constant bigemeny as I was off sotolol for 5 half lives -- prior to ablation).  My RV EF has always been between 55-60% on all tests.  

Could my EF actually be fluctuating this much?  Which test would be the most reliable in determining EF?  Could the PVC's during the ventriculargram have made it difficult to tell what my EF actually was?  Finally, what is the significance of having a low LV EF?

Thank you kindly for your time,
Josie

[Cleveland Clinic]

Remember that most of the time the EF is visually estimated and as long as it is greater than 50 to 55% is considered normal.  The PVC's could have influenced the ventriculogram giving a falsely low impression.  More importantly, however, the PVC's could also weaken the heart to the point where the EF would drop considerably.  Treating the PVC's either with medicaitons or with PVC ablation typically resolves the low EF.  Low EF means that the heart is not pumping as well which may affect your ability to exercise or perform physically challenging tasks.  There are many causes to low EF.  most commonly heart attacks or high blood pressure cause it.  PVC's can cause it to decline as well, although this is very rare.  I have certainly seen it and the good news is that the prognosis from that particular cause is very good as long as the PVC's can be controlled.      

[Cleveland Clinic]

MRI is the best modality that we have to look for ARVD.  this would definitely have to be done once the PVC's are better controlled because of the timing that is required for the study to be interpretable.

[josie490]

One last thing,  on the report it said that " Coronary angriography and left ventriculography were normal with a LVEDP of 7 mmHg and a reduced LV-EF (visual estimate) of 40%.  We would like to send the RV angiograms to Dr. Frank Marcus (Rochester, NY) who is a world expert in the diagnosis of ARVC and has plenty of experience in interpreting right ventriuclar angriograms.  By our local interpretation, the angriogram is not interpretable because all four of the views obtained consisted mostly of PVBs" . We then recieved a follow up report from Dr. Marcus that said, "Quality of angio excellent, except for PVCs that made evaluation extremely difficult.  What is interpretable seems normal.  To be certain, may want to consider a follow up angiogram when PVCs are under control"