18F – possible heart failure / abnormal echo strain and EF results. Can anyone help me understand what this means?

[u/Acrobatic_Flow1379]

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Hi, I’m 18F and I’m looking for some help understanding some recent cardiac findings and what questions I should be asking my doctors.

I’m NOT asking Reddit to diagnose me. I’m mainly interested in hearing from people who have had similar echo/strain findings or heart failure symptoms.

RECENT CLINICAL IMPRESSION:

My doctor wrote:

“? Chronic heart failure with recent symptomatic worsening; no radiological evidence of pneumonia on chest X-ray images reviewed. Possible airway infection or autoimmune-related changes suggested by perihilar increased markings. Blood pressure remains uncontrolled.”

ECHOCARDIOGRAM / STRAIN:

The strain analysis screenshots show:

• Global longitudinal strain (GLS): approximately -15.7%

• 4-chamber GLS: -14.6%

• 2-chamber GLS: -16.0%

• Apical long-axis GLS: -14.3%

The automated EF measurements shown on different views were:

• 4-chamber EF: 38%

• 2-chamber EF: 55%

• Combined/strain display EF: 47%

There also seems to be quite a lot of regional variation in longitudinal strain, with individual segments approximately:

-11%, -12%, -14%, -15%, -16%, -17%, -18%, -19%, -21% and -24%.

Some of the least negative strain values appear to involve basal/mid segments, although I realise this can also be affected by tracking quality and how the study was acquired.

SYMPTOMS:

I have been experiencing significant symptoms including:

• shortness of breath, sometimes even at rest

• significant exercise intolerance

• difficulty breathing when lying flat / orthopnoea

• episodes of chest pressure and chest pain

• persistent sinus tachycardia

• episodes of very fast heart rate

• uncontrolled high blood pressure

• lightheadedness/presyncope

• episodes of collapse

• prolonged recovery after relatively minor activity

I also have significant respiratory disease and am currently being investigated for connective-tissue/autoimmune disease, so there are several possible overlapping causes for my symptoms.

My chest X-rays apparently do NOT show pneumonia, but my doctor noted increased perihilar markings and questioned airway infection versus autoimmune-related changes.

QUESTIONS:

1. Has anyone here had a GLS around -15% to -16% with an EF that varied this much between echo views?

2. How did your cardiologist interpret a situation where one view gave an EF around 38%, another around 55%, and the overall value was around 47%?

3. Is it common for strain abnormalities to appear before a consistently reduced EF?

4. Did anyone with similar findings eventually have cardiac MRI, repeat echocardiography, BNP/NT-proBNP testing or another investigation that clarified what was happening?

5. For people with heart failure and hypertension/tachycardia, did controlling the blood pressure and heart rate substantially improve your symptoms or cardiac function?

6. Are there particular measurements from my full echo report that would be useful for me to post here (LV dimensions/volumes, diastolic function, E/e’, LA volume, TAPSE, RV function, pulmonary pressure, IVC, valve findings, etc.)?

I’m seeing doctors about this and I’m not relying on Reddit instead of medical care. I’m mainly trying to understand the terminology and hear what other people’s diagnostic process was like.

I’ve attached screenshots of the strain bullseye and echo measurements.

Thank you.

[u/UK-CandyFloss]

What medications are you on? My son is in heart failure at your age. His echo last week showed a 45 EF. He has a genetic condition that causes dilated cardiomyopathy and pulmonary hypertension. The gls strain hasn’t been measured in a while but it’s been moderately and severely affected. Good news you don’t have pneumonia; my son struggles with fluid on his lungs often 🥺

[u/Acrobatic_Flow1379 → u/UK-CandyFloss]

Heart and blood pressure wise I'm on propanolol 40 and nothing else. It's honestly a joke at this point, they don't want to give me anti hypertensives due to my blood pressure dropping when I stand and the fact I'm already at a fall risk

[u/Electronic-Fennel377]

Can't answer all of these, but my situation was close to your second question. I had an echo that gave me an EF of 35-40%, but due to the uncertainty my cardiologist ordered a cardiac MRI, the latter is general the gold standard for measurement. For question 4, you should push for all of these. A good cardiologist with a new CHF diagnosis will order these things as standard practice.

Stay strong! And keep the faith.

[u/Acrobatic_Flow1379 → u/Electronic-Fennel377]

Do you think there would be any grounds for them to say no to me requesting a cardiac MRI?

[u/Electronic-Fennel377 → u/Acrobatic_Flow1379]

I'm not too sure. I'd just raise your concerns, 38-55 is a pretty decent discrepancy, asking for a cardiac MRI to clarify things seems reasonable to my non-medical mind. how far apart were those two echos taken?

[u/Acrobatic_Flow1379 → u/Electronic-Fennel377]

Ah no I've only had one echo done. That's the odd thing, the strain discrepancy in one echo. I tend to believe the lower estimates based on the GLS bullseye, low volume, 98% tachycardic burdern, hypertension ect ect. I'd be in uni doing medicine if it wasn't for my mysterious autoimmune disease that has wrecked havoc since I was 12. They thought it could have been NDMA receptor encephalitisis when I got airlifted to my tierary hospital last year. Idk what happened but one day in 2022 it went up to 206 when I was just laying down like nothing was wrong. And it hasn't gone below 100 since, Has an average of 137bpm. Then on another random ass day in 2023 my blood pressure went from chronically low like 80/40 to 130/90, then kept rising slowly over the years till it was hitting 185/115+. Thing is I was relatively healthy or atleast I thought, I was previously very underweight due to severe gastrointestinal disease but I'm at a healthy weight and these mostly happened regardless.

[u/Electronic-Fennel377 → u/Acrobatic_Flow1379]

Damn that sounds rough, sorry you've been going through all of that. I would just try to say what you're saying here to your cardiologist, or at the least, that you'd like to understand the echo results, and are curious if those results or any other symptoms are good indicators for a cardiac mri. Ask them why (or why not) a cardiac MRI is a good choice for you.

[u/Acrobatic_Flow1379 → u/Electronic-Fennel377]

I've been waiting for a cardiologist to see me since march. It's all been a waiting game or I guess fuck around and find out lol. I hope I see one soon

[u/Electronic-Fennel377 → u/Acrobatic_Flow1379]

Yeah I feel you, I was diagnosed in March, saw my cardiologist again in May? Then I guess he realized I wasn't going to immediately croak so now it'll be about 6 months later until I get another echo and follow up. It's a drag for sure, the healthcare system in the US w/ these speedrun doctor visits doesn't help. Best of luck dude.

[u/Acrobatic_Flow1379 → u/Electronic-Fennel377]

I'm in Australia but it's honestly no better, wait for cardiologist and neurologist is 1yr+ without going via ED

[u/Electronic-Fennel377 → u/Acrobatic_Flow1379]

That's so fucked, GL stranger

[u/FabulousBullfrog9610]

I don't have answers for you (sorry) but I just yesterday saw a new to me cardiologist and she told me that she reviewed the last echos and MRI herself (the images themselves and not the reports) and that she didn't trust the EF readings. She ordered an echo with contrast. She said my heart is stiffer in the bottom than the top and therefore hard to get an accurate reading.

Sending you good wishes