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What Does My ECG Test Report Indicate?
Question: Had an echocardiogram today because of shortness of breath. Shows three different ejection fractions- from 55- 60- MOD sp4 (59.9), MOD sp2(57) and MOD bp (55.8)Which is most accurate? Had an echo just three weeks ago which simply states EF is 60. Could my EF be going down? Is modified 4 chamber view more reliable than other views at measuring EF?
Also, one week ago my BNP was measured at 12. Today n-ProBNP was 67. I know they are different and both values are normal but I have read that in healthy people, the values are usually similar. Could this be a problem developing? In metabolic testing, BUN level also XXXXXXX to 13 from 8.
Also, one week ago my BNP was measured at 12. Today n-ProBNP was 67. I know they are different and both values are normal but I have read that in healthy people, the values are usually similar. Could this be a problem developing? In metabolic testing, BUN level also XXXXXXX to 13 from 8.
Brief Answer:
Your cardiac tests look quite normal.
Detailed Answer:
Hello!
Thank you for asking on HcM!
(1) Regarding your Echo derived EF, I would explain that a biplane (bp) volumetric method for EF evaluation is more accurate that just a M-Mode or one plane view.
All the above EF values are within normal ranges, and their variation is a matter of inter- and intra-observer accuracy in underlining the endocardial border when using a volumetric method, or in measurement plane acquisition, etc.
So, relax! Your heart is not playing any tricks. It is just a matter of evaluation method and technique accuracy.
(2) Both of your BNP and NT-proBNP are within normal ranges and you should not worry at all! They are used for the same purpose, but can't be interchangeable and their results can not be directly compared.
When judging about possible variations, this can be performed only when taking serial measurements of only BNP or NT-proBNP.
Your BNP and NT-proBNP do not support any cardiac explanations of your shortness of breath. Sometimes, they may be increased in individual with kidney disease, but your BUN level are quite normal. So, relax again!
To conclude, there is nothing abnormal form all the above cardiac tests.
Another way to rule in/out a cardiac reason of your dyspnea, is by using tissue doppler techniques during cardiac ultrasound for excluding elevated diastolic ventricular pressures and heart failure with preserved EF, etc.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Your cardiac tests look quite normal.
Detailed Answer:
Hello!
Thank you for asking on HcM!
(1) Regarding your Echo derived EF, I would explain that a biplane (bp) volumetric method for EF evaluation is more accurate that just a M-Mode or one plane view.
All the above EF values are within normal ranges, and their variation is a matter of inter- and intra-observer accuracy in underlining the endocardial border when using a volumetric method, or in measurement plane acquisition, etc.
So, relax! Your heart is not playing any tricks. It is just a matter of evaluation method and technique accuracy.
(2) Both of your BNP and NT-proBNP are within normal ranges and you should not worry at all! They are used for the same purpose, but can't be interchangeable and their results can not be directly compared.
When judging about possible variations, this can be performed only when taking serial measurements of only BNP or NT-proBNP.
Your BNP and NT-proBNP do not support any cardiac explanations of your shortness of breath. Sometimes, they may be increased in individual with kidney disease, but your BUN level are quite normal. So, relax again!
To conclude, there is nothing abnormal form all the above cardiac tests.
Another way to rule in/out a cardiac reason of your dyspnea, is by using tissue doppler techniques during cardiac ultrasound for excluding elevated diastolic ventricular pressures and heart failure with preserved EF, etc.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So would you say the 59.9 on echo today means EF has not changed? Are small changes normal? Yet anothee echo in May measured EF at 60.1 through Teichholz. At that time I also had nuclear stress test which showed EF of 63.
I have recovered from PVC-induced cardiomyopathy after ablation and EF dropped as low as 25-30 so I'm very scared of cardiomyopathy coming back and so EF fallind even one number is scary to me. Also my lisinopril was discontinued 3 1/2 months ago and carvedilol being lowered (now at 6.25 2x a day down from 9.375) and then discontinued so worried EF will go lower when all meds are stopped.
Thank you so much, dr.
I have recovered from PVC-induced cardiomyopathy after ablation and EF dropped as low as 25-30 so I'm very scared of cardiomyopathy coming back and so EF fallind even one number is scary to me. Also my lisinopril was discontinued 3 1/2 months ago and carvedilol being lowered (now at 6.25 2x a day down from 9.375) and then discontinued so worried EF will go lower when all meds are stopped.
Thank you so much, dr.
Brief Answer:
You are on the right way of dealing with your health issues.
Detailed Answer:
Hello again dear XXXX!
As I explained you before, your slightly different EF values, do not show any pathological decreases in cardiac performance. 59.9, 60.1 and even 63% (which seems to be the more accurate measurement, as derived by nuclear imagine test), account for an acceptable variation inhereted in examiner and applied method accuracy.
Even in individuals without any prior cardiopathy history, these variations are always present.
So relax! Nothing to worry about!
Your arrhythmia induced cardiomyopathy seems to be completely recovered (as is used to happen when arrhythmia is timely controlled).
You don't seem to be at risk of cardiomyopathy relapse, as long as your arrhythmia is properly treated (the arrhythmic focus seems to have been completely destroyed by ablation).
So relax once more, and enjoy your life!
Medications tapering off (as guided by your attending doctor), once more shows you are on the right way of dealing with your prior cardiac issues.
Hope to have been helpful!
Best regards! Dr. Iliri
You are on the right way of dealing with your health issues.
Detailed Answer:
Hello again dear XXXX!
As I explained you before, your slightly different EF values, do not show any pathological decreases in cardiac performance. 59.9, 60.1 and even 63% (which seems to be the more accurate measurement, as derived by nuclear imagine test), account for an acceptable variation inhereted in examiner and applied method accuracy.
Even in individuals without any prior cardiopathy history, these variations are always present.
So relax! Nothing to worry about!
Your arrhythmia induced cardiomyopathy seems to be completely recovered (as is used to happen when arrhythmia is timely controlled).
You don't seem to be at risk of cardiomyopathy relapse, as long as your arrhythmia is properly treated (the arrhythmic focus seems to have been completely destroyed by ablation).
So relax once more, and enjoy your life!
Medications tapering off (as guided by your attending doctor), once more shows you are on the right way of dealing with your prior cardiac issues.
Hope to have been helpful!
Best regards! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much. Dr. Iliri,
So would you say that even measuring on echo is still only an estimate? As prior echo read 60 EF, I feel uncomfortable that new report reads anywhere from 56-60. Is MOD spBP the biplane method of measurement? Is it more accurate than MOD sp4? MOD sp4 was 59.9 and MOD spBP was 56.7 and while not huge, it makes a big difference in my mind. Also what is Teichholz? Another echo measured my EF at 60.1 Teichholz. Also cardio took measurements in under 1 minute when I asked for calculations and not just visual estimate. I just wonder if he was careful and did it thoroughly.
As you can see, emotionally EF in 50s vs 60s is very different for me. I would like to think nuclear stress at 63 was most accurate but my cardio says echo is much more accurate.
I want to be able to think "EF is over 60 so relax." But these are all estimates so is 56 and 60 essentially the same? It's just that 56 is just one point into normal and seems could so easily slip into the borderline category.
How can I be sure EF is solidly normall when numbers are always different? So anxious
Thank you!
So would you say that even measuring on echo is still only an estimate? As prior echo read 60 EF, I feel uncomfortable that new report reads anywhere from 56-60. Is MOD spBP the biplane method of measurement? Is it more accurate than MOD sp4? MOD sp4 was 59.9 and MOD spBP was 56.7 and while not huge, it makes a big difference in my mind. Also what is Teichholz? Another echo measured my EF at 60.1 Teichholz. Also cardio took measurements in under 1 minute when I asked for calculations and not just visual estimate. I just wonder if he was careful and did it thoroughly.
As you can see, emotionally EF in 50s vs 60s is very different for me. I would like to think nuclear stress at 63 was most accurate but my cardio says echo is much more accurate.
I want to be able to think "EF is over 60 so relax." But these are all estimates so is 56 and 60 essentially the same? It's just that 56 is just one point into normal and seems could so easily slip into the borderline category.
How can I be sure EF is solidly normall when numbers are always different? So anxious
Thank you!
Brief Answer:
Clinical condition is the best marker of so many numerical parameters.
Detailed Answer:
Hi XXXX!
You should be very happy to have experienced such a drastic improvement of your LV EF from 25 - 30% to the actual value of around 60% (=/-).
This is a great success of nature and medical treatments.
My advice is to not pay so much attention to those unimportant EF differences (derived from interobserver and applied technique methods inaccuracy).
EF is a traditional echo marker of cardiac systolic performance. It may be measured by Teichholz method (based on change of LV dimension), or Simpson method (LV volume change - biplane volumetric method), the latter being more accurate than the first.
There are other markers of cardiac performance as well, measuring not only radial, but also longitudinal and torsional LV function. So, please don't be so addicted after echo - derived LV EF. It is just an old surrogate.
A more accurate measurement of LV EF is obtained by cardiac CT or MRI.
Remember from 50 to 56, or even 63 is quite a distinct difference. But this picture has nothing to do with the a cardiac function deterioration.
If you are going to highly consider those numeric changes, you are never going to relax.
The most important thing is your actual well being, and the optimistic view your attending doctor is trying to offer you. That's my opinion!
Greetings! Dr. Iliri
Clinical condition is the best marker of so many numerical parameters.
Detailed Answer:
Hi XXXX!
You should be very happy to have experienced such a drastic improvement of your LV EF from 25 - 30% to the actual value of around 60% (=/-).
This is a great success of nature and medical treatments.
My advice is to not pay so much attention to those unimportant EF differences (derived from interobserver and applied technique methods inaccuracy).
EF is a traditional echo marker of cardiac systolic performance. It may be measured by Teichholz method (based on change of LV dimension), or Simpson method (LV volume change - biplane volumetric method), the latter being more accurate than the first.
There are other markers of cardiac performance as well, measuring not only radial, but also longitudinal and torsional LV function. So, please don't be so addicted after echo - derived LV EF. It is just an old surrogate.
A more accurate measurement of LV EF is obtained by cardiac CT or MRI.
Remember from 50 to 56, or even 63 is quite a distinct difference. But this picture has nothing to do with the a cardiac function deterioration.
If you are going to highly consider those numeric changes, you are never going to relax.
The most important thing is your actual well being, and the optimistic view your attending doctor is trying to offer you. That's my opinion!
Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Iliri,
Thank you so much. I understand focusing so much on numbers will drive me crazy as it is already making me crazy. However, I had accepted that my EF was 60 and then new echo shows 55-60. Would you be quite sure nothing had changed? As the 4 chamber view shows 60- perhaps I will ignore the other numbers. Does this echo show Simpson biplane method of measurement? I believe it must have been automatically generated as it was instant.
My fear with 55-60 is that a drop of even one point then puts me in the borderline category. How can I stop worrying when its so close to the line of being a bit too low?
Thank you so much. I understand focusing so much on numbers will drive me crazy as it is already making me crazy. However, I had accepted that my EF was 60 and then new echo shows 55-60. Would you be quite sure nothing had changed? As the 4 chamber view shows 60- perhaps I will ignore the other numbers. Does this echo show Simpson biplane method of measurement? I believe it must have been automatically generated as it was instant.
My fear with 55-60 is that a drop of even one point then puts me in the borderline category. How can I stop worrying when its so close to the line of being a bit too low?
Brief Answer:
A thorough review of your ECHO reports would be necessary.
Detailed Answer:
Hello!
I think we have progressed on cardiac tests, and have forgotten the most important issue; that is your clinical status: possible symptoms and signs.
A progressive dropping of cardiac performance, as you are afraid of (facing those numeric values), would be reflected on your actual clinical status.
But fortunately, the odds are not in favor. You are in perfectly good clinical conditions, and this is another details to be highly considered.
In order to have an exhaustive conclusion about your EF uncertainties, I would ask you to find the possibility and upload all your available ECHO reports (including films) for a professional review.
Best wishes,
Dr. Iliri
A thorough review of your ECHO reports would be necessary.
Detailed Answer:
Hello!
I think we have progressed on cardiac tests, and have forgotten the most important issue; that is your clinical status: possible symptoms and signs.
A progressive dropping of cardiac performance, as you are afraid of (facing those numeric values), would be reflected on your actual clinical status.
But fortunately, the odds are not in favor. You are in perfectly good clinical conditions, and this is another details to be highly considered.
In order to have an exhaustive conclusion about your EF uncertainties, I would ask you to find the possibility and upload all your available ECHO reports (including films) for a professional review.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri. I am uploading three echo reports, but only one contains any actual images. The other two are just reports. Also including the nuclear stress report.
Brief Answer:
You have a steady normal cardiac performance.
Detailed Answer:
Dear XXXX!
I reviewed all your uploaded cardiac tests (2 cardiac ultrasounds performed on XXXXXXX and July 2015, and SPECT performed on May 2015).
These tests are performed so close to each other, that it is impossible to find a professional explanation for those different EF values.
As I have explained you before, this may be explained only by inter-observer (examiner) differences on accuracy.
The most reliable measurement results are produced by SPECT.
So, to conclude, there is nothing wrong with your heart.
There isn't any real progressive deterioration of your cardiac performance.
In fact, your heart seems perfectly normal (from all the performed tests).
So relax! Nothing dangerous is going to happen. Enjoy your life!
Regards,
Dr. Iliri
You have a steady normal cardiac performance.
Detailed Answer:
Dear XXXX!
I reviewed all your uploaded cardiac tests (2 cardiac ultrasounds performed on XXXXXXX and July 2015, and SPECT performed on May 2015).
These tests are performed so close to each other, that it is impossible to find a professional explanation for those different EF values.
As I have explained you before, this may be explained only by inter-observer (examiner) differences on accuracy.
The most reliable measurement results are produced by SPECT.
So, to conclude, there is nothing wrong with your heart.
There isn't any real progressive deterioration of your cardiac performance.
In fact, your heart seems perfectly normal (from all the performed tests).
So relax! Nothing dangerous is going to happen. Enjoy your life!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri! I have attached one more report from may and the final report from two days ago. So do you think it's accurate to say my EF is 60 as nuclear stress said 63 and most of the echoes too? My concern is that echo from this week says 56 although 4 chamber view is 60. Do you think it's possible anything changed in three weeks between echoes?
It is my anxiety, I know but having been so sick, and yet without many symptoms, I keep thinking echo is only way to tell if I'm ok and it seemed maybe EF had dropped a little. I want to trust that I have recovered but get so scared. Also my lisinopril was discontinued 3 1/2 months ago and carvedilol is also being withdrawn. 6 weeks ago, carvedilol went from 9.375 twice a day to 6.25 twice a day. So also worried that may cause a change. PVCs are infrequent now, but I get scared when I feel one. Before ablation I had 65,000 a day!
It is my anxiety, I know but having been so sick, and yet without many symptoms, I keep thinking echo is only way to tell if I'm ok and it seemed maybe EF had dropped a little. I want to trust that I have recovered but get so scared. Also my lisinopril was discontinued 3 1/2 months ago and carvedilol is also being withdrawn. 6 weeks ago, carvedilol went from 9.375 twice a day to 6.25 twice a day. So also worried that may cause a change. PVCs are infrequent now, but I get scared when I feel one. Before ablation I had 65,000 a day!
Brief Answer:
Nothing wrong is going to happen with your heart.
Detailed Answer:
Hi,
The more ECHOs you compare, the more confounding will be the picture you see.
I advise you just to relax yourself, and try to relieve your anxiety, as nothing abnormal is going to happen with your heart.
60 and 63 show the same cardiac performance, but this same picture is offered to you through different windows (one represented by SPECT, which is more accurate, and the other by ECHO, less accurate).
That's my simplified explanation for you.
Regarding the above mentioned therapy, I would explain that, it does affect cardiac performance indexes like EF measured by the above tests.
Most probably, an ACEI (lisinopril) continuation would be helpful as a maintenance therapy.
Nevertheless, it depends on your attending doctor discretion to decide the right strategy for you (as he knows better your whole medical history).
Hope to have been helpful, and have fulfilled your expectations.
Best wishes,
Dr. Iliri
Nothing wrong is going to happen with your heart.
Detailed Answer:
Hi,
The more ECHOs you compare, the more confounding will be the picture you see.
I advise you just to relax yourself, and try to relieve your anxiety, as nothing abnormal is going to happen with your heart.
60 and 63 show the same cardiac performance, but this same picture is offered to you through different windows (one represented by SPECT, which is more accurate, and the other by ECHO, less accurate).
That's my simplified explanation for you.
Regarding the above mentioned therapy, I would explain that, it does affect cardiac performance indexes like EF measured by the above tests.
Most probably, an ACEI (lisinopril) continuation would be helpful as a maintenance therapy.
Nevertheless, it depends on your attending doctor discretion to decide the right strategy for you (as he knows better your whole medical history).
Hope to have been helpful, and have fulfilled your expectations.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri,
I know I am being driven by anxiety and it must be hard to keep saying the same thing over and over and feel I'm not understanding. I understand on one level but fear takes over my brain and the questions come back.
Primarily right now I am concerned about echo of two days ago which shows EFs of 55-60 and cardio wrote on report that it was 56. So seems to me possible EF dropped from just 3 weeks ago when cardio wrote 60. It seems significant to me unless I only look at the 59.9. Why would that one view be different than the others? You say EF is 60. If you think that remains so on latest echo, then I feel more reassured. Thank you. And I apologize for being so anxious and frustrating!
I know I am being driven by anxiety and it must be hard to keep saying the same thing over and over and feel I'm not understanding. I understand on one level but fear takes over my brain and the questions come back.
Primarily right now I am concerned about echo of two days ago which shows EFs of 55-60 and cardio wrote on report that it was 56. So seems to me possible EF dropped from just 3 weeks ago when cardio wrote 60. It seems significant to me unless I only look at the 59.9. Why would that one view be different than the others? You say EF is 60. If you think that remains so on latest echo, then I feel more reassured. Thank you. And I apologize for being so anxious and frustrating!
Brief Answer:
You are welcome!
Detailed Answer:
Hello XXXX!
Your arrhythmia was totally controlled after cardiac ablation.
There is not any scientific evidences to support a LV EF deterioration in such a short period of time.
Measuring EF by ECHO, is frequently a subject of combined quantitative and qualitative evaluations judgement by the examiner.
As such the possibility of error and considerable standard deviation is always present.
That's the truth in your case.
Nothing wrong is going to happen with your heart.
I highly recommend to make every effort and don't allow anxiety to take the best of you.
Greetings! Dr. Iliri
You are welcome!
Detailed Answer:
Hello XXXX!
Your arrhythmia was totally controlled after cardiac ablation.
There is not any scientific evidences to support a LV EF deterioration in such a short period of time.
Measuring EF by ECHO, is frequently a subject of combined quantitative and qualitative evaluations judgement by the examiner.
As such the possibility of error and considerable standard deviation is always present.
That's the truth in your case.
Nothing wrong is going to happen with your heart.
I highly recommend to make every effort and don't allow anxiety to take the best of you.
Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri. But I can't help to ask one more time if the 59.9 on my latest echo in 4 chamber mode suggests that some drs would have called my EF 60 rather than 56. I am so terribly frightened of some lowering of EF since my medications have been stopped (lisinopril) and lowered (carvedilol). I just have never seen an echo report before with multiple EF readings and wondering how much comfort I can take from the one 59.9.
Also still worrying very much about the 67 proBNP compared to 12 BNP as I've read that while they are not the same, in healthy people the number is similar on both tests. Do you often see this discrepancy where ProBNP is higher?
Trying to control anxiety but not having an easy time.
Thank you. I am hoping and hoping that I can feel my last echo still showed 60 EF from some views and that that is significant.
Thank you so much.
Also still worrying very much about the 67 proBNP compared to 12 BNP as I've read that while they are not the same, in healthy people the number is similar on both tests. Do you often see this discrepancy where ProBNP is higher?
Trying to control anxiety but not having an easy time.
Thank you. I am hoping and hoping that I can feel my last echo still showed 60 EF from some views and that that is significant.
Thank you so much.
Brief Answer:
An ECHO follow up is helpful.
Detailed Answer:
Hello XXXX!
I will not try to confound much further your uncertainties about echo derived cardiac performance or even lab tests results (BNP & NT-proBNP).
As you know already my opinion on the matter, I would explain also that all the above indexes (EF or lab markers) ae helpful to delineate better a possible new or worsening heart failure.
But, from the other side, heart failure is a clinical syndrome, and this is more important that every possible laboratory cardiac index.
So, as far as your symptomatology doesn't show any deteriorating progress, then all the above cardiac indexes need further evaluation and validation.
The best thing to achieve the above and relieve your anxiety, is to repeat after a couple of months your cardiac ultrasound. It will confirm professional opinion on the matter.
Regards.
Dr. Iliri
An ECHO follow up is helpful.
Detailed Answer:
Hello XXXX!
I will not try to confound much further your uncertainties about echo derived cardiac performance or even lab tests results (BNP & NT-proBNP).
As you know already my opinion on the matter, I would explain also that all the above indexes (EF or lab markers) ae helpful to delineate better a possible new or worsening heart failure.
But, from the other side, heart failure is a clinical syndrome, and this is more important that every possible laboratory cardiac index.
So, as far as your symptomatology doesn't show any deteriorating progress, then all the above cardiac indexes need further evaluation and validation.
The best thing to achieve the above and relieve your anxiety, is to repeat after a couple of months your cardiac ultrasound. It will confirm professional opinion on the matter.
Regards.
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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