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Low Ejaction Franchise echo? #282535
02/01/19 06:17 PM
02/01/19 06:17 PM
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worldofme Offline OP
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So I had an echo last year, which show 66% as an ef and today it shows 60% ef. I also have all three of the valves leaking. I don't see the doc until few weeks later.

Does AS lower your ef?

Re: Low Ejaction Franchise echo? [Re: worldofme] #282536
02/01/19 06:35 PM
02/01/19 06:35 PM
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Winston Offline
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You have 4 valves, not three. Trace regurgitation is a normal finding. Almost everybody (90+% of people) has slightly leaky valves. As for the ejection fraction, between 50-75% is normal.

Last edited by Winston; 02/01/19 06:36 PM. Reason: error in word choice
Re: Low Ejaction Franchise echo? [Re: worldofme] #282545
02/02/19 11:31 PM
02/02/19 11:31 PM
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worldofme Offline OP
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Yes, the 4th aorta valve was fine no trace nothing. Just the other three show some leaking.

My concern is drop in ejection fraction why?

Is it AS or uncontrolled inflammation no one seems to tell me. The doc said hes not sure and hasn't really seen a patient with AS and heart issue. This guy is an ep doc.

Does no one here have any valve or arrithmyia issue?

All specialist like to look at everything from there stand point not as holistic.

Re: Low Ejaction Franchise echo? [Re: worldofme] #282558
02/04/19 03:18 PM
02/04/19 03:18 PM
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Winston Offline
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AS typically affects the aortic valve and the area of the heart around the aortic valve. Your aortic valve is fine, right?

I think you're placing too much weight on that ejection fraction measurement. Judging ejection fraction from an echocardiagram is as much art as science. The technician is literally looking at static and trying to make some sense of it. They're trying to take a 3-dimensional measurement from a combination of 2-dimensional pictures. If the pictures are slightly different angles or the quality isn’t as good from one year to the next, the measurements will be different. Also, the patient is not the same from one hour to the next, let alone one year to the next. Your ejection fraction will be different if you've just exercised or if you're dehydrated, to give just two examples. The important thing is that the measurements stay within the normal range, which yours were. So, unless your cardiologist (who sees the big picture, as opposed to just one tiny measurement) has told you otherwise, relax.

Re: Low Ejaction Franchise echo? [Re: worldofme] #282559
02/04/19 11:15 PM
02/04/19 11:15 PM
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worldofme Offline OP
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Winston,

I picked up my echo report and I would like to point that in the report said left atrium is complete normal. However, when looking at the report it self and the range it doesn't look normal to me. For instance left atrium range is 2.9 to 4.0 and my value is 3.9. So I am right there above 4.0 assuming on my next echo this will show with mild left atrium.

My mitral vale is complete normal with trace regurgitation along with the BP, which are two main factor cause of enlarge left atrium.

Does spondy do this? Any input on this would be helpful. I know my cardio is going to tell me lets wait and watch, but seriously if this is caused by uncontrolled inflammation than I'm going to start taking TNF.

I have been prescribe TNF drug for ReA since last few months but I refuse to take it because of the side effects it may cause. I guess I might need to start to control inflammation.

As for the aortic valve value have increase since the last echo so not really.

This year

Aortic Root : 3.0 (Range: 2.1 to 3.7)
Ascending Aorta Diameter: 3.2 (Range: 2.1 to 3.6)
Left Atrium: 3.9 (Range : 2.5 to 4.0)

Last year it was:

Aortic Root: 2.8 (Range: 2.1 to 3.7)
Ascending Aorta: 2.9 (Range: 2.1 to 3.7)
Left Atrium: 3.1 (Range: 2.5 to 4.0)



As you can see in one year it has jump significantly. What will it be next year over the limit?

Aortic Valve:
- The Aortic Valve is normal.
- The Aortic Valve is tri-leaflet
- The aortic valve has no stenosis and no regurgitation.

I'm really nervous and not sure if this is uncontrolled inflammation or what.

Last edited by worldofme; 02/04/19 11:30 PM.
Re: Low Ejaction Franchise echo? [Re: worldofme] #282571
02/05/19 04:08 PM
02/05/19 04:08 PM
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WhiteCell Offline
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That is a report of a nearly normal echocardiogram. Many factors influence cardiac values during an echo. Patient position in bed, weight loss or gain. skill of practitioner; I would ask my Rheum and Cardio what they feel the risks would be of using a TNF blocker. If it works you may get a real reduction in symptoms. As TNF blockers work directly to reduce any inflammation, your heart, as well may benefit.


Starting at 18 yrs old; 1971 Reiter's Syndrome. Diagnosed AS 2001.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
Right eye DSEK Cornea Transplant 2009.
Right eye Ahmed Shunt 2016.
Right eye DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by Radio Frequency Ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
Re: Low Ejaction Franchise echo? [Re: worldofme] #282572
02/05/19 04:42 PM
02/05/19 04:42 PM
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Winston Offline
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I agree with WhiteCell. You are placing too much weight (and causing yourself too much stress) over small differences in measurements that may have nothing whatsoever to do with the health of your heart. Just wait and talk to your cardiologist, who will consider these measurements in combination with your clinical presentation and other factors.

You've been going back and forth on the TNF drug issue for years now. I'm not sure there's anything I (or anyone) can say to re-assure it's okay to take the drug. I can tell you that there's no guarantee it will have any positive effect on your heart. It might, but there's not much data on the subject. Just case reports and anecdotes. I can share my own anecdote: I started taking a TNF drug when it was discovered that I had an enlarged aortic root and ascending aorta and a mildly leaky aortic valve. Now, three or so years later, my aorta is stable and my aortic valve is no longer leaky. My cardiologist is reasonably confident that my aorta is not presently inflamed, i.e., is not progressing. I had a conversation with my rheumy about the situation just last week. My rheumy said maybe the Enbrel cleared up the aortic inflammation. But he also said that maybe that inflammation was going to burn itself out anyway, with or without treatment. There's just no way to know for sure. You have to take a leap of faith sometimes with these treatments.

Re: Low Ejaction Franchise echo? [Re: worldofme] #282575
02/05/19 10:22 PM
02/05/19 10:22 PM
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worldofme Offline OP
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Thank you both of you, very much appreciate the feedback.

The reason for my hold back on tnf is i do not have genetic AS that many of you folks have. My arthritis started after some sort of uti (reactive arthritis) therefore my concern about infection is so real as in what if the infection is still there and tnf make it worse?

I guess it's something i'll need to take risk on but you see where I'm coming f4om on this?

Re: Low Ejaction Franchise echo? [Re: worldofme] #282578
02/06/19 01:39 AM
02/06/19 01:39 AM
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WhiteCell Offline
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Perhaps this may contain information for you.

https://www.ncbi.nlm.nih.gov/pubmed/21538314


Starting at 18 yrs old; 1971 Reiter's Syndrome. Diagnosed AS 2001.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
Right eye DSEK Cornea Transplant 2009.
Right eye Ahmed Shunt 2016.
Right eye DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by Radio Frequency Ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
Re: Low Ejaction Franchise echo? [Re: worldofme] #282598
02/08/19 06:58 PM
02/08/19 06:58 PM
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worldofme Offline OP
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But that study is so small 10 people?


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