Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Is The Life Expectancy When Suffering From Stage 4 Heart Failure?
Question: My mom is 86 yrs old and had a dobutamine echo. AO valve 1.0cm22. AV peak vel 3.72 Mean pressure garden 32 mm HG. EF was 25%. Post dobutamine av peak gel was 4.1m/s. MPG was 39 and ava was 1.0, EF was not much improved. HR was 59 to 69. Target HR was 114. Would she benefit from valve surgery or is she in cardiomyapathy. Is she stage IV by definition? and if her EF went from 55% to 25% in 18 months does that mean that she has a year to live most likely?
Brief Answer:
It is difficult to predict whether she will benefit or not
Detailed Answer:
Hi,
The case of your mother is one if most difficult situations we face in the management of aortic stenosis. Her EF didn't improve during stress echo, which means there is no contractile reserve. And gradient increased slightly. In these patients TAVI is indicated as valve replacement procedure, but benefits from valve replacement is difficult to predict. Anyway after the replacement her heart will make less efforts to pump the blood through aortic valve, so she may benefit. About stage 4 heart failure it depends whether she is breathlessness in rest, and if she has oedemas. Actually these patients don't have good life expectancy, but you should know that it is in general, we have patients who live two years and even more.
Hope I could help you
Wishing a good health to your mother
In case of further questions don't hesitate to ask
Regards,
It is difficult to predict whether she will benefit or not
Detailed Answer:
Hi,
The case of your mother is one if most difficult situations we face in the management of aortic stenosis. Her EF didn't improve during stress echo, which means there is no contractile reserve. And gradient increased slightly. In these patients TAVI is indicated as valve replacement procedure, but benefits from valve replacement is difficult to predict. Anyway after the replacement her heart will make less efforts to pump the blood through aortic valve, so she may benefit. About stage 4 heart failure it depends whether she is breathlessness in rest, and if she has oedemas. Actually these patients don't have good life expectancy, but you should know that it is in general, we have patients who live two years and even more.
Hope I could help you
Wishing a good health to your mother
In case of further questions don't hesitate to ask
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
( I am a nurse). If my moms EF and HR did not increase during dobtumaine echo..that means she has no reserve. what does that mean? I understand if she exercises she will be sob. What about other stresses?? what about flying?? She has family 3000 miles away. What if her family stresses her? I want to fly her out there. Is sept/ oct this year to late?? or is spring next year to late for her to be able to go.. I know it is difficult to predict. She is not sob at laying down or at rest. Can her EF on two echoes be wrong? What questions do I need to ask her cardiologist to get the most out of her visit and see what is going on?
Brief Answer:
Welcome back
Detailed Answer:
Dear Mrs,
During exercise our organism need more oxygen and heart works harder to deliver it, so usually there is a rise in ejection fraction. It is contractile reserve. The same is during stress, but less. Severely impaired heart muscle cannot contract harder, as it works with its maximum forces during the rest. That's why such patients have dyspnea during exercise.
About what you should ask your doctor: I think at first you should discuss the possibility of surgery (TAVI), pros and contras. Also you should discuss her optimal treatment for heart failure.
Sometimes there are good results on treatment despite low ejection fraction. I think the possibility of her flight should be discussed in two months after treatment, and it will depend her heart failure functional class.
Regards,
Welcome back
Detailed Answer:
Dear Mrs,
During exercise our organism need more oxygen and heart works harder to deliver it, so usually there is a rise in ejection fraction. It is contractile reserve. The same is during stress, but less. Severely impaired heart muscle cannot contract harder, as it works with its maximum forces during the rest. That's why such patients have dyspnea during exercise.
About what you should ask your doctor: I think at first you should discuss the possibility of surgery (TAVI), pros and contras. Also you should discuss her optimal treatment for heart failure.
Sometimes there are good results on treatment despite low ejection fraction. I think the possibility of her flight should be discussed in two months after treatment, and it will depend her heart failure functional class.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi thank you for answering me. My mom's ejection fraction went from 50% to 25 and all other values are normal. Is t her heart just worn out? And what is the interior diameter of a tavr valve?
Brief Answer:
Welcome back
Detailed Answer:
Dear Mrs,
TAVR valves have different diameters, there are three types depending patient's diameter of aorta. Usually diameter of aorta is measured carefully with transesophageal or 3D echo and the correct size is chosen.
About the decrease the ejection fraction; there should be a reason for decrease of ejection fraction, either myocardial infarction or cardiomyopathy due to aortic stenosis.
Regards,
Welcome back
Detailed Answer:
Dear Mrs,
TAVR valves have different diameters, there are three types depending patient's diameter of aorta. Usually diameter of aorta is measured carefully with transesophageal or 3D echo and the correct size is chosen.
About the decrease the ejection fraction; there should be a reason for decrease of ejection fraction, either myocardial infarction or cardiomyopathy due to aortic stenosis.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi again,
1.Can a TAVR be done with a 5 cm aneurysm in the aortic arch?
2.Wouldn't a BNP be a diagnostic tool for cardiomyopathy?
3. would a TAVR be done with a BNP over 550?
My mom sees her doctor on Tues. I am just wondering.
4. I am wondering more about the inner diameter when the valve starts working. i see the different sizes but they show the OD. If my moms valve is 1.0 cm2 and a new valve put in with open heart surgery is 1.22 cm2, we were told she would not feel any relief 18 months ago. I you place a valve inside her valve it is a curious question. Will the ID be larger than 1.0 cm2? Thank you
Hi,
Also, when I read about the TAVR it seems that all studies have only been done for 2 years. Is that the expected life of the valve? Can you replace it if it fails or do you have to have open heart surgery for this?
1.Can a TAVR be done with a 5 cm aneurysm in the aortic arch?
2.Wouldn't a BNP be a diagnostic tool for cardiomyopathy?
3. would a TAVR be done with a BNP over 550?
My mom sees her doctor on Tues. I am just wondering.
4. I am wondering more about the inner diameter when the valve starts working. i see the different sizes but they show the OD. If my moms valve is 1.0 cm2 and a new valve put in with open heart surgery is 1.22 cm2, we were told she would not feel any relief 18 months ago. I you place a valve inside her valve it is a curious question. Will the ID be larger than 1.0 cm2? Thank you
Hi,
Also, when I read about the TAVR it seems that all studies have only been done for 2 years. Is that the expected life of the valve? Can you replace it if it fails or do you have to have open heart surgery for this?
Brief Answer:
Welcome back
Detailed Answer:
Dear Mrs,
The aorta should be studied carefully, if there is enlargement of ascending aorta, TAVR cannot be performed. But not only the diameter of aorta, there are many other parameters, that patient should fit to considered suitable for the procedure. It is not possible to define on-line, you will discuss it with your doctor after examinations.
TAVR is larger than 1.0 cm, but as I wrote earlier not all patients are suitable for the procedure.
There are not long term studies, because it is quite new technic, but the results are good, especially in experienced centers.
BNP is a good marker not only for the severity of heart failure, but also for the prognosis. And more important is it's changes over time. If it decreases with treatment, it is a good prognostic sign. It means that heart failure is compensating.
Hope this was of help
Wishing a good health to your mother
Regards,
Welcome back
Detailed Answer:
Dear Mrs,
The aorta should be studied carefully, if there is enlargement of ascending aorta, TAVR cannot be performed. But not only the diameter of aorta, there are many other parameters, that patient should fit to considered suitable for the procedure. It is not possible to define on-line, you will discuss it with your doctor after examinations.
TAVR is larger than 1.0 cm, but as I wrote earlier not all patients are suitable for the procedure.
There are not long term studies, because it is quite new technic, but the results are good, especially in experienced centers.
BNP is a good marker not only for the severity of heart failure, but also for the prognosis. And more important is it's changes over time. If it decreases with treatment, it is a good prognostic sign. It means that heart failure is compensating.
Hope this was of help
Wishing a good health to your mother
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you
Brief Answer:
You are welcome
Detailed Answer:
Wishing a good health to your mother
Regards,
You are welcome
Detailed Answer:
Wishing a good health to your mother
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi again,
Maybe last question !
Her ascending aorta is now 48mm (was normal 5 years ago)
Her arch a few years ago was 46mm. (was normal 5 years ago)
I assume these are somewhat large.
With her EF and these, I don't really expect that she is a surgical candidate for TAVR,
nor do I really expect that she is going to live much longer. It is compounded with her only issue of thick blood and HCT hoovers around 48 for many years.
Is my assessment correct?? Thank you
Maybe last question !
Her ascending aorta is now 48mm (was normal 5 years ago)
Her arch a few years ago was 46mm. (was normal 5 years ago)
I assume these are somewhat large.
With her EF and these, I don't really expect that she is a surgical candidate for TAVR,
nor do I really expect that she is going to live much longer. It is compounded with her only issue of thick blood and HCT hoovers around 48 for many years.
Is my assessment correct?? Thank you
Brief Answer:
With such aortic dimensions probably she will be not suitable for TAVR
Detailed Answer:
Dear Mrs,
With such aortic dimensions most probable her case will not be suitable for the TAVR.
So the only option can be medical treatment and you can follow BNP. The prognosis will be highly dependent on BNP levels, if it decreases over time, it will be a good prognostic sign.
Regards,
With such aortic dimensions probably she will be not suitable for TAVR
Detailed Answer:
Dear Mrs,
With such aortic dimensions most probable her case will not be suitable for the TAVR.
So the only option can be medical treatment and you can follow BNP. The prognosis will be highly dependent on BNP levels, if it decreases over time, it will be a good prognostic sign.
Regards,
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
