Asymptomatic LVSD

[Hillmorton Scubie]

Is it recommended to abstain from diving, following an echocardiogram diagnosis of asymptomatic left ventricular systolic dysfunction.

 

[headsqueeze]

No.

LVSD is a subjective interpretation of the wall motion identified by echocardiography. So just by itself, it is not something to worry about.

Why you had the echocardiogram is more important to discuss and may indeed preclude diving. If you share more information then we can give you a tailored reply.

 

[Hillmorton Scubie]

The GP recommended it after hearing an S3 at a routine check up

 

[headsqueeze]

No worries! Sounds like you have a careful GP and one worth keeping.

 

[Dr. Doug Ebersole]

Wait a minute. As a cardiologist I can't just let "no worries" about LVSD slide by without a couple of caveats as some of the readers here may get the wrong impression. Left ventricular dysfunction (LVEF < 50%) is a wide ranging condition with a whole host of possible mechanisms. In general, most diving authorities recommend divers have normal LV function to dive whether the condition is caused by coronary artery disease, valve disease, etc. That having been said, there are young healthy athletes who have S3 on exam and "athletic hearts" that can have a calculated LVEF < 50% and are perfectly healthy. Just my 2 cents, but if you were my patient I would recommend further evaluation -- not just for diving, but for your overall health.

 

[Hillmorton Scubie]

Thanks for your comments and advice

 

[headsqueeze]

Over the years LVSD has been described in my experience ranging anywhere from subjective wall motion abnormalities to decreased *calculated* left ventricular ejection fraction as debersole mentioned. The cutoff <50% calculated EF is also up for debate (some physicians have placed the calculation 5% higher in my experience). Echocardiograpy is a great tool, but it does not measure left ventricular ejection fraction; it is a subjective calculation and is prone to not only error but subjective interpretation and skill of the technician (non-physician) performing the study. LVEF measured by catherization is the gold standard which of course carries an unacceptable morbidity and mortality for scubie.

"Asymptomatic", without unexpected structural cardiac findings on echocardiogram would appear to me as sufficient clinical evidence for safe diving given the amount of information shared by scubie.

 

[Dr. Doug Ebersole]

Everyone is entitled to their professional opinion, but I would have to disagree with the statement:

"Asymptomatic", without unexpected structural cardiac findings on echocardiogram would appear to me as sufficient clinical evidence for safe diving given the amount of information shared by scubie."

I would not be wiiling to clear him without seeing him personally, but that is just me.

Doug

PS: Cardiac cath is definitely NOT a gold standard for LVEF as it is limited by the assumptions in the Dodge Area Length calculation. There is no true "gold standard". A good quality LV gram, a good quality echo, a good quality gated CT or MRI, and a good quality MUGA are all adequate tests for LVEF if their quality is good. Unfortunately, each of these has inherent limitations in a variety of patient subsets.

 

[headsqueeze]

PS: Cardiac cath is definitely NOT a gold standard for LVEF as it is limited by the assumptions in the Dodge Area Length calculation. There is no true "gold standard". A good quality LV gram, a good quality echo, a good quality gated CT or MRI, and a good quality MUGA are all adequate tests for LVEF if their quality is good. Unfortunately, each of these has inherent limitations in a variety of patient subsets.

Thank you for clarifying the point. Of all the tests mentioned, the only one that requires a physician physically present aside the patient, taking the time and effort to ensure a proper test is the catheterization. Technicians who are in charge of all the other examinations often do not have the skillset comparable to you. It is your skill and knowledge as a Cardiologist that I find more informative than an examination performed by those less so, no matter how sophisticated the technology.