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Worst Heart Scan (Echo) To Date

  • Thread starter Deleted member 106824
  • Start date

homonunculus

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A consideration:


https://www.researchgate.net/profil...jection-fraction-Are-they-interchangeable.pdf

"Visual estimation, wall motion scoring, biplane Simpson's method and 3D echocardiography should not be used interchangeably for serial assessment of left ventricular ejection fraction."

-------------

https://onlinelibrary.wiley.com/doi/pdf/10.1111/echo.12331"

"Further studies are required to assess the clinical value of contrast 3D ECHO as noncontrast 3D ECHO is only reliable in patients with good acous- tic windows. (Echocardiography 2014;31:87–100)


Blood pressure is always low normal. Even when I was on gear I never had elevated BP.

This is excessive, but here are the results from every echo I've ever gotten. As you can see, my worst was 2015-2016. Things seemed to really improve in 2017-2018 once I went on Valsartan but now I'm back to my worst dilation ever and low ejection fraction despite still being on Valsartan:

1. Echo 10/28/2014:

EF: 50% (> 55)






2. Echo 9/25/2015:
EF: 40% (> 55)


3. Echo 2/2/2016:

EF: 40% (> 55)

4. Echo 9/5/2017:

EF: 56% (3D) EF > 52

4. Echo 9/5/2017 (Stress Echo):

EF: 56% (vistual est. EF > 52


5. Echo 10/23/2018:
EF: 55% (biplane), 62% (2D)

6. Echo 11/8/2019:


EF: 50% (3D echocardiography)


7. Echo 8/12/2020:


EF: 46% (3D echocardiography)
 
D

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A consideration:


https://www.researchgate.net/profil...jection-fraction-Are-they-interchangeable.pdf

"Visual estimation, wall motion scoring, biplane Simpson's method and 3D echocardiography should not be used interchangeably for serial assessment of left ventricular ejection fraction."

-------------

https://onlinelibrary.wiley.com/doi/pdf/10.1111/echo.12331"

"Further studies are required to assess the clinical value of contrast 3D ECHO as noncontrast 3D ECHO is only reliable in patients with good acous- tic windows. (Echocardiography 2014;31:87–100)

Thanks Scott. I'd have to go back and look at the methods used, usually they will state whether it was 2D or 3D. My cardiologist said 2D this time was 47-48% and she didn't like the 3D on this scan (which was 46%).

Regarding the 2nd article, it definitely shows the wide variability between methods, will save that one for sure. If I had had just one or even two tests at this point I would be more open to the idea that my lower EFs are actually normal, but at this point with so many echos showing lower than expected numbers and all echos and MRIs showing large volumes I think it's a safe bet to say those are reasonably correct. I would love to find out that the change between them has been arbitrary, and just due to normal variations between scans and interpreters. I think that is a possibility and something I pray is true. But it does seem like the lower EF and larger volumes are legitimate. Why they are that way...whether due to previous AAS, or something genetic, or thyroid use, or my IBD I have no idea. Looking at that 2nd article man my volumes are way larger than the upper limits they mention. My 2D measurements (LVEDD) in terms of millimeters are larger, but my volumes both on MRI and echo are way larger.
 

nothuman

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A consideration:


https://www.researchgate.net/profil...jection-fraction-Are-they-interchangeable.pdf

"Visual estimation, wall motion scoring, biplane Simpson's method and 3D echocardiography should not be used interchangeably for serial assessment of left ventricular ejection fraction."

-------------

https://onlinelibrary.wiley.com/doi/pdf/10.1111/echo.12331"

"Further studies are required to assess the clinical value of contrast 3D ECHO as noncontrast 3D ECHO is only reliable in patients with good acous- tic windows. (Echocardiography 2014;31:87–100)

One time I had an echo with a 77% ejection fraction and I freaked out to the point I had a panic attack over it. I wish they were 100% accurate all the time
 

whacked

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& Magnesium (Taurate would be a good one)

I'm sure you know this already but here's what I would be taking if I was in your situation.

Arjuna
(Life Extension Cardio Peak)

Ubiquinol
-200mg 2-3x daily

Ribose
-10 grams per day

Taurine
-2 grams per day
 

homonunculus

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Thanks Scott. I'd have to go back and look at the methods used, usually they will state whether it was 2D or 3D. My cardiologist said 2D this time was 47-48% and she didn't like the 3D on this scan (which was 46%).

Regarding the 2nd article, it definitely shows the wide variability between methods, will save that one for sure. If I had had just one or even two tests at this point I would be more open to the idea that my lower EFs are actually normal, but at this point with so many echos showing lower than expected numbers and all echos and MRIs showing large volumes I think it's a safe bet to say those are reasonably correct. I would love to find out that the change between them has been arbitrary, and just due to normal variations between scans and interpreters. I think that is a possibility and something I pray is true. But it does seem like the lower EF and larger volumes are legitimate. Why they are that way...whether due to previous AAS, or something genetic, or thyroid use, or my IBD I have no idea. Looking at that 2nd article man my volumes are way larger than the upper limits they mention. My 2D measurements (LVEDD) in terms of millimeters are larger, but my volumes both on MRI and echo are way larger.

I forgot that the site now compresses quoted text: Check what I quoted from your post. I clipped away all but the EF and noted methodology:


1. Echo 10/28/2014:
EF: 50% (> 55)
2. Echo 9/25/2015:
EF: 40% (> 55)
3. Echo 2/2/2016:
EF: 40% (> 55)
4. Echo 9/5/2017:
EF: 56% (3D) EF > 52
4. Echo 9/5/2017 (Stress Echo):
EF: 56% (vistual est. EF > 52
5. Echo 10/23/2018:
EF: 55% (biplane), 62% (2D)
6. Echo 11/8/2019:
EF: 50% (3D echocardiography)
7. Echo 8/12/2020:
EF: 46% (3D echocardiography)

It looks like the used 3D the last couple times.

Yes, with a larger LVEDD, you'll de facto have a smaller ejection *fraction* mathematically. Some individuals who are predisposed to endurance activity might also tend to have cardiac adaptation more like that seen in endurance athletes, i.e., a larger ventricle size and smaller EF (but larger SV in proportion to the reduced resting heart rate).


What's your HR at rest?

-S
 
D

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I appreciate you taking the time to address this Scott :)

The article you posted is good, below are some good ones I've saved as well (2nd and 3rd have a lot of tables and figures showing standard values and contrasting athletes with cardiomyopathy patients).

https://www.sciencedirect.com/science/article/pii/S0033062012000047

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.106.613562

https://asecho.org/wp-content/uploa...ocardiogr-Profiling-of-the-Athletes-Heart.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639332/

My RHR can be as low as 40-45 while dieting, but in general tends to be 45-60bpm.

Even the top cardiologist I spoke to said that IF I was an endurance athlete this would be less concerning. That if I was a marathon runner, or cyclist, etc these would be somewhat normal. The concern comes from that fact that, other than a few years in high school when I played sports, my cardio over the years has been 30-120min per week of LISS with on average one short HIIT session per week, and low volume workouts with long rest periods. My VO2 max was tested at 49....quite average for my age given I'm active and in shape (slightly above average in charts but that's for all individuals not just athletic ones). And if you look at the charts in the studies on athletes' echo dimensions my dimensions would still be on the right tail end and that's among true endurance athletes.

Again I'd love to believe this is just a normal response to my training. I just don't see it in all of the echos of normal healthy active individuals I see (for example my brother's and dad's echos were normal) and I'm getting larger measurements than legitimate elite athletes.

Regarding the methodology of the echos, it looks like 3D was used in 2017 which seemed to be my best (the one at Cleveland Clinic with the sports cardiologist) and the last 2 I had in 2019 and 2020 were also 3D and trending down from 56% --> 50% --> 46%

I know you think I'm pessimistic :) lol I just don't want to ignore a real issue. This new cardiologist has suggested bumping my Valsartan from 80mg to 100mg and I'm not so sure about that...I already get quite a bit of orthostatic hypotension
 
D

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The fun don't stop. Literally none of the 7 cardiologists or ~10 doctors I've seen over the last 5-6 years and discussed this with have mentioned my dilated inferior vena cava to me. Normal is ~17mm and in 2016 I had a reading of 29.9mm. Subsequent echos have shown dilated IVC (though they now just say ">21mm indicating elevated right atrial pressure"). Not a single doctor has mentioned that, what it means, why it could be dilated and why my right atrium could be dilated, nothing. While I know the biggest importance is on left ventricular size and function the more I look at my scans in detail the more it looks like pretty much my entire heart is dilated to various degrees.

I dropped my TRT from 120mg to 70mg 6 weeks ago. I did an exercise stress test 2 weeks ago and am waiting to have my appointment follow up with the sports cardiologist here. My VO2 Max was normal / slightly above average for my age.
 

maldorf

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How they analyze the VO2 max is rather poor since they compare you to a sedentary population.

Its funny because I have heart failure and an EF of 20%. They said my VO2 max was normal for my age.

The bad thing is that none of us have the measurement of our body when our heart was fit. So can't compare.
 
D

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How they analyze the VO2 max is rather poor since they compare you to a sedentary population.

Its funny because I have heart failure and an EF of 20%. They said my VO2 max was normal for my age.

The bad thing is that none of us have the measurement of our body when our heart was fit. So can't compare.

Yea, I'm glad the VO2 max isn't shitty but the fact that it's only marginally above average for my age doesn't really mean much. Not that I do a lot of cardio but I exercise much more than the average person so I should be scoring significantly higher than average anyway. VO2 max is influenced by genetics as well but can be increased significantly with training.

On the extreme end of things performance matters, like if you are immediately winded then there's clearly a problem, but plenty of athletes on anabolics are performing at peak levels until suddenly they're not...

I'd kill to know what a scan of my heart looked like before taking any anabolics.
 

maldorf

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Yea, I'm glad the VO2 max isn't shitty but the fact that it's only marginally above average for my age doesn't really mean much. Not that I do a lot of cardio but I exercise much more than the average person so I should be scoring significantly higher than average anyway. VO2 max is influenced by genetics as well but can be increased significantly with training.

On the extreme end of things performance matters, like if you are immediately winded then there's clearly a problem, but plenty of athletes on anabolics are performing at peak levels until suddenly they're not...

I'd kill to know what a scan of my heart looked like before taking any anabolics.
If I were you, I'd not be overly concerned with the exact # of your ejection fraction buy rather think more about how you feel. If you're able to do everything you want and feel good doing it then you're ok. Getting the echos done every few years is probably a good idea, to just make sure that things aren't going downhill bad. Some minor variance isn't anything to worry about, not sure how much can be due to interpretation.

Haven't you asked your cardiologists about your enlarged vena cava? I would want to know more about that.
 
D

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If I were you, I'd not be overly concerned with the exact # of your ejection fraction buy rather think more about how you feel. If you're able to do everything you want and feel good doing it then you're ok. Getting the echos done every few years is probably a good idea, to just make sure that things aren't going downhill bad. Some minor variance isn't anything to worry about, not sure how much can be due to interpretation.

Haven't you asked your cardiologists about your enlarged vena cava? I would want to know more about that.

I agree, the change from one echo to the next and a downward trend is what I am most concerned about. It's hard to go by symptoms as I've had random jolts of chest pain for years but no clear reason why. I'm also hesitant to only go by feel...as I mentioned John Meadows had a heart attack and now his ejection fraction is 35% yet he feels fine, a lot of people feel ok then suddenly keel over. But I am grateful I don't have exercise intolerance.

No one has ever mentioned that enlarged IVC to me before. I have that follow up with the new sports cardiologist as I was unimpressed with the original cardiologist they gave me here, I'll ask her about it. I know it can be enlarged in athletes but want to get clarification on the extent and if it means anything new for me (the results page only says >21mm whereas in 2016 my results from another hospital gave a precise measurement of 29.9mm). Studies I've looked up show a worse outcome with larger IVC dilation.
 

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