Nuclear Stress Test - High LVEF?

Posted by mayoconnectuser1 @mayoconnectuser1, 2 days ago

Hi All,

Quick status from next stage of investigating my high CAC score - have a longer thread from my initial high CAC test at https://connect.mayoclinic.org/discussion/high-cac-score-and-current-status/.

Still asymptomatic, but cardiologist thought time for nuclear stress test (Myocardial Perfusion Imaging (MPI).
- Walked for 8 min 18 sec
- 9.9 METS
- 135 bpm heart rate
- High functional capacity for age/gender.
- Images show small defect/inferior wall. Very small and mild.
- Gated post stress LVEF was normal, with calculated EF of 78%. During graded exercise testing, the patient did not have chest pain with no angina during exercise. The ECG did not demonstrate ischemic changes.

So, my quick read says 78% EF is high (above 75% is considered concerning) and might be associated with Hypertrophic CardioMyopathy (HCM). Not sure what other causes there would be, but still reading.

My previous stress test with echo had for the baseline component, an "estimated LVEF in the range of 55-65%," and for the peak stress component, "appropriate reduction in left ventricular size ... EF estimated at 70%." However, further into that report, this: 2D, EF biplane 80.4, and LVEF MOD A4C 78.4. My understanding is the A4C means it uses this method to determine the EF.

Thoughts?

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delphiniums | @delphiniums | 2 days ago

I don't know how helpful this will be, but my husband has had dozens of different stress tests, lexiscan stress tests, MRIs, echos, and other imaging over the past year. He's dealing with reduced EF, however...

The range is error is very broad and we've also seen how much it varies depending on who is doing the reading. For instance, his local echos consistently estimate his EF at 25% to 30% but his echo at Mayo put him at 17% — which was confirmed by an MRI at 18% the following month.

It's also my understanding that when under stress, EF increases. For instance, his most recent Lexiscan stress test put him in the 40s.

I would hope they'll order additional imaging to confirm your EF before they use it to steer treatment, especially if it's just ~3% from normal. And if they don't, I'd advocate for yourself. Diagnostics and *repeat* diagnostics have completely transformed the understanding of my husband's condition and his treatment this past year.

Good luck to you!

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