ESD vs EDD

[heartfulloflove]

Tonight while I was looking for ejection fraction info for someone else, I came across this:

"The residual volume of blood within the ventricle is increased (increased end-systolic volume) because less blood is ejected."

It's talking about systolic dysfunction, apparently.

My questions are:

Does an increased end systolic measurement indicate weakening of the pumping function of the heart by itself, or must an increased end diastolic measurement also be present? Does increased ESD or EDD come first or is it simultaneous?

My cardiologist said he wasn't concerned because I was only out of normal on one measurement, being the ESD...but from what I've been reading, that is the more important measurement...the one that is indicative of decreased contractility associated with the PPCM he suspected originally that I may have been developing. So now I feel all sick to my stomach with worry again, just when I finally found some peace of mind.

[JAMESFETT]

Shannon, I tend to agree with the information you understand coming from your cardiologist. The EDD tells how much dilatation (enlargement of left ventricle) your heart has experienced and the ESD tells how effective the ventricle is pumping the blood, since the higher ejection fraction, the smaller will be the ESD. Your numbers are really very good, and I think you can be content that you have made much progress and that you are very nearly normal. I also look at the Fractional Shortening, which takes both ESD and EDD into consideration and is derived by the formula:

EDD - ESD
FS = _________

EDD

and normal is considered over 30 percent. You can plug your exact numbers into that formula and see where the level comes out. In general over 30 percent FS equates with over 50 percent EF. Just another way of looking at the same function of the left ventricle pumping action. I think you can take great reassurance from your numbers.

JDF

[JAMESFETT]

P.S. The formula didn't appear in the final message in the same way as I typed it in. To clarify, I hope, this is what it is saying:

FS = [ESD-EDD] divided by EDD

Is that clear?

JDF

[heartfulloflove]

Thank you Dr. Fett. According to that formula, my FS is around 25, based on the measurements of 3.60 ESD and 4.77 EDD at diagnosis. He originally was going to start me on a medication to "shrink my heart", but opted not to after my MUGA scan afterward was normal.

Apparently he felt that the EDD could be normal for being 11 weeks postpartum also, though this wasn't the case with my previous pregnancy. He said he has 12 patients in his practice that he currently treats for PPCM, so I feel 98% confident in him as far as knowing what to look for. I'm just concerned mostly for gauging the safety of a future pregnancy, and he seems incredibly supportive of it...though he doesn't tend to offer much detail on what actually happened to my heart this time. Thats what eats at me.

I did have "stiffness" of my heart during diastole following my first pregnancy, which resolved by a 6 month follow-up. Is that relevant or related in any way?

I'm less concerned now basically because the info I came across last night wasn't anything new, it was just worded differently and I was tired (read: adrenaline prone) when I read it.

[JAMESFETT]

You are in an "in-between" category in which some cardiologists would use an ACE-I and/or a B-B treatment and some would not. Generally we think of the MUGA as the "gold standard" compared to either EF or FS by echo. If the MUGA were not available (as is the case with my practice in Haiti) we depend upon the EF and FS by echo, and during the first year following diagnosis we keep the treatment going with either an ACE-I or a B-B. Your next echo may reflect the better MUGA, and I hope that will be the case.

JDF

[heartfulloflove]

I hope so too. Thank you again.