question for Dr. Fett-understanding contractile reserve

[BrookeT]

Dr. Fett

I just went for my stress test and received my results, which were good. The nurse that called me with results could not tell me what my Contractile reserve was. During my test, the cardiologist in the room said my contractile reserve was great. I am going to list everything on my result sheet.

HR-at rest 75
HR-peak-176
BP-at rest 95/61
BP-at peak 142/85

Estimated LVEF is at 60%
Maximum heart rate achieved was 176, which is 95% of the maximum(186 beats/min)

The patient(me) followed a Bruce protocol The patient exercised to stage 4.

Let me know your thoughts. I did schedule a doc appt. with Dr. Bogaev to discuss and really to answer any more questions for my husband. He is the one I need to get on board. I followed all the protocol for getting pregnant again. I am hoping to get my husband and family on board with our decision to go ahead with another pregnancy.

If you would like I could fax you the results.

Thanks so much!

[JAMESFETT]

Does the report list your LVEF at rest? Does it list your LVEF at maximum heart rate? Those are the two components that are still lacking on the info you have given. The difference is the contractile reserve on exercise stress echo. The B.P. gain with exercise is good.

JD

[BrookeT]

It states:

Left Ventricle:The endocardium is adequately visualized. Normal left ventricular chamber size. All segments are hyperkinetic. Hyperdynamic LV systolic function. Estimation of left ventricular systolic function is less reliable in teh presence of tachycardia. Estimated LVEF is 60%.

Left Atrium: not well visualized

Stress: Patient followed a Bruce protocol. The patient exercised into stage 4. The study was terminated because of fatigue. The patient did not express feelings of chest discomfort. The blood pressure response is adequate. Exercise capacity is good. There were no arrythmias. There is no ST segment depression. This is a negative echocardiographic stress test.


That is all that I have...please tell me that if the information is not here that they can still get from this test?? Thank you so much for all your help.

[JAMESFETT]

I think that means that at target exercise rate the EF was 60 %. Now, ask them what the EF was at resting prior to exercise. Having both of those numbers will enable you to know the contractile reserve, which is the difference between the two. Example 50 to 60, 10 points gain, contractile reserve 20 %. Example 55 to 60, 5 points gain, contractile reserve 10 %. ("Adequate contractile reserve" = 7 to 15 %)

[BrookeT]

Great, thank you so much.

[BrookeT]

I spoke to the nurse. She said my Ef at rest was 60% and at peak was above 60%. So what does this mean?

[JAMESFETT]

It would help to know the maximum it attained. I wouldn't venture to say anything about it without that information.

JD

[BrookeT]

Thank you, I see Dr. Bogaev on the 24th. I'll know I'll be able to get the information from her.

[BrookeT]

Dr. Fett,

If my contractile reserve does not show a gain of 7-15%, would you not recommend a post pregnancy? I am going to the doctor tomorrow and writing out a list of questions, but would love to know your thoughts.

Reading my report more clearly says at rest LVEF is 60% and at peak LVEF is 60%. I'm kind of scared now! Please let me know.

Thanks so much,

Brooke

[JAMESFETT]

EF of 60 per cent is good, but lack of gain at peak exercise is concerning because relapse of heart failure in a post-PPCM pregnancy increases. Estimate of risk of relapse goes up from 10 percent or so to over 25 percent in that situation. Reassessing that in a year could show improvement. This information is just that, no guarantees.

[BrookeT]

Thank you. Not feeling very good going into my appt. tomorrow. Is there anything I can do to help improve the gain at peak exercise?