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Medical Forum / Diseases and Disorders / Breast Cancer / June 2005

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The real story on MUGA scans...

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allan grossman - 28 Jun 2005 23:54 GMT
MUGA scans (Deborah had one today) measure the left ventricle ejection
fraction (LVEF) and are a good indicator of overall heart health.

The LVEF measures the amount of blood being pumped out of the heart
and is measured in percent - a healthy adult will have an LVEF of 50%
or greater.

A MUGA scan provides information that echocardiography cannot.  From
about.com -

http://tinyurl.com/akubd

"The advantages of the MUGA scan over other techniques (such as the
echocardiogram) for measuring the LVEF are twofold. First, the MUGA
ejection fraction is highly accurate, probably more accurate than that
obtained by any other technique. Second, The MUGA ejection fraction is
highly reproducible. That is, if the LVEF measurement is repeated
several times, nearly the same answer is always obtained. (With other
tests, variations in the measured LVEF are much greater.) These
advantages - along with its noninvasive nature - make the MUGA scan
ideal for detecting subtle changes in a patient's cardiac function
over time.

A common clinical situation in which repeated MUGA scans are useful is
in following a patient's cardiac function during the delivery of
chemotherapy for cancer. Some chemotherapeutic agents (adriamycin
being the most notable) can be quite toxic to the heart muscle. By
measuring the MUGA ejection fraction periodically during chemotherapy,
oncologists can determine, on an ongoing basis, whether it is safe to
continue with the therapy, or whether certain medications need to be
stopped. The MUGA scan is accurate and reproducible enough to detect
subtle, early changes in cardiac function that might easily be missed
by other techniques. It is a highly effective, noninvasive means of
monitoring one of the worst side effects of chemotherapy, and allowing
that therapy to be delivered more safely and effectively than would
otherwise be possible."

More stuff -

http://tinyurl.com/9ncau

"The MUGA scan measures the heart's function and the flow of blood
through it. The strongest chamber in the heart is the left ventricle,
which serves as the main pump of blood through the body. The left
ventricular is assessed by measuring the amount of blood pumped with
each heartbeat (the ejection fraction), ventricle filling, and the
blood flow into the pumping chamber. A normal ejection fraction is 50%
or more. The heart's ejection fraction is one of the most important
measures of its performance. The right ventricle's ability to pump
blood to the lungs is also assessed, and any abnormalities in the
heart wall are identified. The MUGA scan is the most accurate,
non-invasive test available to assess the heart's ventricles."

Still more stuff...

http://tinyurl.com/bmzp8

"Multiple Gated Acquisition - MUGA for short - measures how well your
heart is functioning as a pump, much like an echo does, but more
accurately. The MUGA measures how much blood your heart pumps, or
"ejects" with each contraction (EF) and how quickly that blood is
ejected. EF is actually figured with a mathematical formula : EF =
(end diastolic volume - end systolic volume) divided by (end diastolic
volume - background). The nuclear camera (gamma camera) can separate
left heart function from right heart function by using a certain view,
called left anterior oblique.

Because this test is very accurate for measuring EF, it is preferred
by some doctors. However, MUGA equipment is both more scarce and more
expensive than echo equipment. It requires an injection of a
radioactive material and is also more uncomfortable for the patient.
MUGA does not "see" valve disease as well as an echo. If you have lung
disease, this is the test of choice to measure EF because echo does
not work well for people with lung disease.
    Remember that with this test, images that are taken during
irregular beats are rejected. That's why patients with multiple odd
ventricular beats like PVCs require longer scan times to gather enough
"good data." MUGA is not suited for patients with a really irregular
heart rhythm. Echo has the same problem but not as badly."

Signature

allan

we don't see things as they are, we see them as we are.
-- Anais Nin

Eva - 29 Jun 2005 01:38 GMT
> http://tinyurl.com/akubd
>
[quoted text clipped - 4 lines]
> highly reproducible. That is, if the LVEF measurement is repeated
> several times, nearly the same answer is always obtained.
----------
Yes, this is what I was trying to explain as the disadvantage of the
echocardiogram.  There is an element of subjectivity.  Two different
operators can give you two different scores.

Eva
Annie - 29 Jun 2005 07:37 GMT
Allan,
I was just coming in here to post to you, and find out how things are
going for you and Deb. I hope all is well with both of you. I've not
seen anything from you recently and was wondering how things were going
up there.
And as always thanks again dear for posting the information that you
did about the Muga Scan. I had one before my chemo started in Jan. 03.
I came through it quite well. The only part that I found uncomfortable
was laying on my back for the length of time that it took. But the tech
were able to put a wedge under my knees that helped alot.
The Muga Scan is required here before you start chemo, because as you
mentioned the Adriamycin is quite toxic to the heart, as others can be
also.

I had a scheduled check up with my bc surgeon today and everything went
well, nothing silly going on, and everything where it should be, and
I'm VERY happy about that. I was 2 years out from chemo on 6/6/05.
YeeHaw! Geez! time fly's when you're having fun. :-/
You both take care and God bless. Give my best to Deb and tell her she
remains in my thoughts and prayers.
annie
Mary Fisher - 29 Jun 2005 10:07 GMT
> Allan,
> I was just coming in here to post to you, and find out how things are
> going for you and Deb. I hope all is well with both of you. I've not
> seen anything from you recently and was wondering how things were going
> up there.

Yes, Allan, some news would be good. Neither of you is forgotten.

> I had a scheduled check up with my bc surgeon today and everything went
> well, nothing silly going on, and everything where it should be, and
> I'm VERY happy about that. I was 2 years out from chemo on 6/6/05.
> YeeHaw! Geez! time fly's when you're having fun. :-/

Indeed. I'm happy for you!

Mary
allan grossman - 29 Jun 2005 10:07 GMT
>Allan,
>I was just coming in here to post to you, and find out how things are
[quoted text clipped - 17 lines]
>remains in my thoughts and prayers.
>annie

Hi, annie -

We're doing well - it's great to hear from you.  My best to you and
yours.

Signature

allan

we don't see things as they are, we see them as we are.
-- Anais Nin

Barb - 29 Jun 2005 14:18 GMT
Hi Allan,
I've been thinking about you too....Glad to hear that you and Deb are doing
well. Please tell her I send my regards!
Barb

> We're doing well - it's great to hear from you.  My best to you and
> yours.
allan_grossman@hotmail.com - 29 Jun 2005 15:00 GMT
Thanks, Barb  ;-)

We're doing well.  Deborah's markers are on the rise again and she had
a MUGA scan and bone density test yesterday in preparation for next
Wednesday's visit with Dr. Smiley.  We think he's going to try adding
Navelbine back to the Herceptin and may swap out the Arimidex for
another aromatase inhibitor, but so far things are going really well.
It's not time to worry yet, but it looks like it may be time for us to
get back in the fight.  We'll know more next week  ;-)

hugs to all -
Mary Fisher - 29 Jun 2005 15:10 GMT
> Thanks, Barb  ;-)
>
[quoted text clipped - 5 lines]
> It's not time to worry yet, but it looks like it may be time for us to
> get back in the fight.  We'll know more next week  ;-)

Do let us know ...

> hugs to all -

And gentle hugs back!

Mary
Barb - 29 Jun 2005 16:20 GMT
I didn't realize the markers were rising until after I sent my last note and
then saw an older post that told that.  You've got a lot to think about.
Just hate the waiting between tests and appointments (too much thinking
time).  Your Dr. Smiley sounds like a gem, and that's a huge positive, also
a plus that there are agents yet to try.  Prayers and hugs winging from
north central Pennsylvania.
Barb

> We're doing well.  Deborah's markers are on the rise again and she had
> a MUGA scan and bone density test yesterday in preparation for next
[quoted text clipped - 5 lines]
>
> hugs to all -
Bea - - 29 Jun 2005 18:21 GMT
>It's not time to worry yet, but it looks like it may
> be time for us to get back in the fight. We'll
> know more next week ;-)
hugs to all -

Allan,  how fantastic it would be if all husbands of wives who have bc
considered themselves "in the fight" as you wrote above.   I think the
most terrifying part of this is feeling it is "our" disease and "our"
fight alone.  What a source of strength you must be for your Deborah!
She is a very lucky lady.    

Can I clone you, please? <g

Bea
allan grossman - 30 Jun 2005 01:44 GMT
>Allan,  how fantastic it would be if all husbands of wives who have bc
>considered themselves "in the fight" as you wrote above.   I think the
[quoted text clipped - 3 lines]
>
>Can I clone you, please? <g

Not sure you'd like that, Bea - I'm not without my own little quirks
;-)

I don't think anyone should have to do this alone.  Sometimes it's the
'worse' part of 'better or worse', but it's still a promise I made -
and I've never regretted making it  ;-)  

Signature

allan

we don't see things as they are, we see them as we are.
-- Anais Nin

Mary Fisher - 30 Jun 2005 10:36 GMT
> I don't think anyone should have to do this alone.  Sometimes it's the
> 'worse' part of 'better or worse', but it's still a promise I made -
> and I've never regretted making it  ;-)

Hurrah!

Mary
Tim Jackson - 29 Jun 2005 08:59 GMT
> MUGA scans (Deborah had one today) measure the left ventricle ejection
> fraction (LVEF) and are a good indicator of overall heart health.
[quoted text clipped - 5 lines]
> A MUGA scan provides information that echocardiography cannot.  From
> about.com -

I think the reason why MUGA is more accurate for measuring the actual
output of the heart is because it is essentially 3-dimensional. It
measures the  VOLUME of blood (because the intensity of the signal at
any point is proportional to the amount of blood visible) whereas
ultrasound gives an essentially 2-dimensional projection, what it sees
are surfaces where density changes, the WALLS of the heart, not the
blood itself.

Echocardiography is better at diagnosing some heart defects, but MUGA is
a good test of overall function, just as measuring the horsepower of an
engine is a good performance indicator but not so useful for fault finding.

Tim Jackson
Mary Fisher - 29 Jun 2005 10:07 GMT
> I think the reason why MUGA is more accurate for measuring the actual
> output of the heart is because it is essentially 3-dimensional. It
> measures the  VOLUME of blood (because the intensity of the signal at any
> point is proportional to the amount of blood visible) whereas ultrasound
> gives an essentially 2-dimensional projection, what it sees are surfaces
> where density changes, the WALLS of the heart, not the blood itself.

I've never heard of MUGA scans and was wondering if we had them here :-)

> Echocardiography is better at diagnosing some heart defects, but MUGA is a
> good test of overall function, just as measuring the horsepower of an
> engine is a good performance indicator but not so useful for fault
> finding.

They did echo scans to check a systolic valve which has been faulty (but not
much) since scarlet fever when I was five. It was, apparently, essential for
me to have a healthy heart so that I could have have dental conservation!

Mary

> Tim Jackson
 
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