Echo Stress test results

I can't comment knowledgeably, sorry, except to say that there is a concept known as the 'standard error of measurement'. You can google it if you wish. Essentially, there will be natural and expected variance in derived results/scores/assessments with each measurement due to operator error, operator variances in technique (different schools, different supervisors with biases ordering certain ways of doing things), instrument variances in calibration and in engineering, and even variances in the interpretation of the data between 'raters', or what they call inter-rater reliability (will two or more specialists looking at the same results arrive at the same conclusions? Nope, not by a long shot! Hence the wisdom of seeking multiple opinions, especially where the stakes are large).

What I am saying is that those results don't vary by a wide margin, so I don't think you should necessarily take them as a sign of progression or worsening. They MAY BE truly a sign of that, but not necessarily. You would want a third reading to show that its very close to the last one or that it's even worse....or marginally better. With that knowledge, what should you make of the third result? So, you should seek a second opinion at least, look for highly similar results in any data derived, and then form an action plan based on a firm consensus over the data.

My AFIB and getting off drugs story, updated as of 10/22/25:
I had AFIB, severe left atrial regurgitation (mitral valve not opening properly), no comorbidities. Valve problem caused it all; the valve problem was caused by a dental procedure that led to a gum infection, that went to my heart valve. It’s not that uncommon from what I understand.
Everyone is different, but here is my experience for what it's worth. I had mitral valve repair, ablation, and LAAC at 78, 3 years and 5 months ago. No more AFIB (it can work permanently). I exercise and eat smartly (low in calories, sugar, salt, and caffeine). I got off Eliquis after four months by wearing a heart monitor for 30 days to be sure AFIB was gone. I had to push my cardiologist to put me on the monitor. My last vital stats while sitting were 119/68, heart rate 68. I have also weaned myself off of 12.5mg metoprolol daily and 81mg aspirin daily. I read a recent JAMA article that said low dose aspirin causes brain bleeding over time. Now it is recommended only for stroke and heart attack victims as I understand it. I have also read that metoprolol interferes with sodium and sugar levels. Too low an amount of sugar or salt can cause dizziness as I read it. Vitals and alertness are better than ever. Daily, I do take a magnesium glycinate supplement containing 29% of RDA. Pure Encapsulations is the best brand I have found. I have read that magnesium and moderate exercise help folks to stay out of AFIB. I had a great surgeon at WakeMed in Raleigh, Dr. Boulton, who did all of the heart stuff. That was key of course. He also supports magnesium supplements. Overall, I feel extremely fortunate.
If you live near and can travel to Raleigh, NC, contact this office to send your test results, especially the latest echo, to the great cardiac surgeon, Dr. Byron Boulton; set up a consultation visit, perhaps by phone. He is Director of the WakeMed Structural Heart Program at WakeMed in Raleigh, NC. Phone (919) 231-6333. I had a serious regurgitation/mitral valve problem (caused by a gum/dental infection) and AFIB. He repaired my mitral valve, did an LAAC, and did an ablation to cure my AFIB. That was over three years ago. I am as fine as wine, off all meds too, except for 4 amoxicillin before dental visits. I am an 81-year-old male, just a kid.

To repeat, everyone is different, but that's my particular story. Lastly, be sure to read "The AFIB Cure" if you have not done so already.
Regards,
Sagan

@saganjames
Hi Sagan,

Thanks for the information.
What type of mitral valve repair did you have. Conventional where they fraction of did you go with minimally invasive like robotic? And, how did you decide?
Lou

I meant to type sternum fracture.

@gloaming
Hi,
I had a stress echo at the Cleveland Clinic 20 years ago. It revealed a +1 mitral valve. In March of this year, the primary care physician ordered a resting echo. Then , she sent me to a cardiologist who ordered this latest stress echo. The doctor that interpreted the resting March echo also did this latest stress October echo. I’m thinking that the stress echo revealed the progression from +2 to +4. What do you think?
Anyway, I probably have to have it fixed before my heart is affected by the leak. So, I’m wondering if you have any opinions about various procedures, like conventional surgery, or some kind of minimally invasive surgery like robotic. I was looking at the MitraClip but it doesn’t seem to be very durable.
Lou

@neronel I unfortunately have no experience with any of this. My problem has been with atrial fibrillation which has been stemmed mechanically through a procedure called catheter ablation (burning to create scarring around the areas where the spurious/extra/rogue signals emanate and cause the underlying substrate to contract and make false beats in chaotic rhythm).

Here is where you have to have faith in those who offer support and advice. If you intuitively trust your cardiologist or EP, and that person says a MitraClip will suffice, at least for this first attempt at remediation, I wouldn't be able to argue differently. If you were to read up on that device, maybe ask in fora where they discuss it, you might learn of limitations that make it somewhat iffy for you, or that it's the apparently best option for the present. I dunno...

Minimally invasive is always the least risky, but the operators are using touch 'n feel and a large screen to help them 'see' what their implements are doing buried about 8 cm inside your chest. Open heart gives them the use of their eyes directly, but you're also opened up. Personally this would be an easy pick for me, and it would be the minimally invasive...at least for a first attempt. It it's a bust, then Attempt the Second would be open chest.

@neronel
I had minimally invasive robotic surgery. I decided to go that way because of the reputation caring manner of Dr. Boulton. Please remember that this surgery, as well as most others, is as much in art as a science. You need a great artist who has done it many many times and maintains a terrific reputation.
Regards,
Sagan

@neronel
First being a heart failure patient with low EF (25) your EF is excellent. That is a positive for you. The fact your ventricles are of normal size is also great news.

I do not have any experience with valve leakage. I would think the echo stress test would be more indicative of your heart functioning ability and issues. I have had many stress tests but not a echo done at same time. I have had many echocardiograms but at rest with contrast.

What brought you to the cardiologist? What were your symptoms? Your EF and ventricle information is excellent I wish mine were that good.

Excellent treatments these days versus even 5 years ago.

@jc76
Hi,
I got a new primary care physician last year at the Cleveland Clinic. She listened for the murmur and ordered a resting echo. The results came back with +2 mitral valve prolapse. She referred me to a cardiologist. He said I need a stress echo. So, here I am. Now, with a +4 mitral valve prolapse. I had a stress echo 20 years ago. It revealed a mild prolapse of +1. So, the murmur has been there, probably all of my life. I guess it worsens with age.

I had first degree heart block but now that has disappeared. It usually gets better or improves with age. Seldom goes to 2nd or 3rd.

I’m meeting with the cardiologist in about 3 weeks. See what he says. They do offer robotic surgery at the Cleveland Clinic. They also give mortality data. Looks very good. They have done 2500 or more.

I was thinking of the MitraClip but that’s not as durable like the surgery. If I live another 10 years it won’t last and then I would have to have surgery anyway but then I would be older. That’s not good. I’m 75.;

Lou

@neronel
You are in good hands at Cleveland Clinic. They have been stated the top cardiovascular hospital in U.S. Cleveland Clinic is known all over the world for that.

I am 78. So let both try to be centurions.