General: 64 year old male, cardio exercise 30 min 4-5 times per week. Recent stress echo Bruce protocol 13 minutes, 13.34 mets, VO2max 46.288, score 98. Max Heart Rate (182), not recommended to exceed MHR, but felt good and tech allowed. Last stress test, non echo, 1 year ago, 13.45 minutes. three years ago 15 minutes.
Echo stress report: Suggested by Cardiologist to establish base line. Base Line images revealed normal LV size and systolic function with no segmental wall motion abnormalities identified. Repeat images a peak stress demonstrated mild anteroseptal hypokinesis. There were no exercise induced arrhythmias however, EKG at peak stress was difficult to interpret.
2 Dimensional Doppler Echo numbers Aortic Root 3.4, Left Atrium 3.6, LVEDD 5.1, LVESD 3.3, IVS 1.3, LVPW 1.3, E.F. approx. 60% Interpretion; 1. Technically difficult study, 2. Normal LV size and function, 3. Mild LVH, 4. Mild AV sclerosis with normal leaflet motion. MV, TV appear normal. There is trace MR and mild TR with RVSP=30-35mmHg, 5. RA/RV appear normal in size and function, 6. No significant pericardial effusion or intracavitary echo densities seen.
Conclusions 1.T.D.S with adequate data quality, 2. Normal L.V. size and function with 60% EF, 3. No significant valve disease.
Cardiologist recommended a SPECT stress echo, however insurance company declined coverage even after peer to peer review. So what does this all mean? I think is fair to assume that at my age and subject to an American diet, that there some level of stenosis in my coronary arteries. The location and level of occlusion is unknown and without further testing we can only approximate based on the previous echo numbers. That said, where do we go from here? Based on the echo numbers, what is my prognosis and is a stress profusion test, paid for out of pocket, worth the time and expense? Or, is a CTA or cath angiogram a better approach, although much more expensive.
Septal Hypokensia is a wall motion defect, although mild in my case. However is does imply some level of occlusion, and in my case possibly LAD associated, and therefor potentially dangerous to ignore. So essentially we are left to guess, without insurance support, about possible outcomes.
Can you all put the echo numbers in perspective for me and possibly provide some direction? Also, is it possible that by exceeding my MHR during the stress test that the numbers or indications may have been effected, or skewed? Regards............JMView Thread
Thank you so much for taking the time to respond. Your insight and experience in interpreting some of the numbers and conditions is very much appreciated. Putting much of the information into perspective is vitally important in understanding what I am facing going forward.
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