MUGA vs. echo

[concerned]

I am new to this and have a question. My mom's oncologist is insisting that a echocardiogram is preferable for monitoring her heart function while on herceptin. Everything I read says MUGA or echo. However, here and on other boards, everyone seems to have MUGAs. Are they more precise? Why wouldn't he want a MUGA? and will they catch any problems as quickly with an echo? My parents mentioned this way she wouldn't need radioactive materials in her...but I read it is trace amounts?

She received a herceptin treatment(started in Dec) on Wed and wound up in the hospital after it was completed...shortness of breath and pain. They ruled out a heart attack and a blood clot in her lungs with CAT Scans, x rays, blood work and stress tests. She is also currently receiving radiation. I get the uneasy feeling that it was the herceptin and we may not be so lucky next time. She goes to the oncologist again on Mon and I'm not ready to let the MUGA scan vs echo rest yet, however, I don't have anything concrete.

Any info would be appreciated. Thanks.

[Sheila]

I believe it is the Oncologists who favor one or the other...the echo is non invasive, no need to use radioactive dyes as they do in CT scans...although they sometimes do inject an inhancer to visualize the ventricle and take measurements...especially if you have an implant on the left sie...makes an echo a little trickier. Some Dr's believe that an echo is more precise and less error factors...also less costly.

[Becky]

A muga is a precise reading done by a computer. Usually you get a number, let's say 62. An echo's ejection factor is "read" by a cardiologist and is usually a range, lets say 60-65 (as an example if the muga said 62). The echo is just as accurate, especially if the same person is reading it everytime. Also, your parents are right about the bit of radiation involved with Muga - who needs it if it is not necessary.


A muga could be called for if a person is on the borderline of 50 and is also either elderly, ill or has known heart problems. That is when an oncologist might want a precise number versus a range.

If your mother continues to tolerate Herceptin (and it gets better and better over time) do not discourage her as it is a life saving drug. Of course, if there a life threatening problems in taking the drug and her doctors want her off, that is another story all together.

Bottom line to your question, there is very little difference between muga and echo.

Hope this helps

[Barbara2]

My onc said a MUGA or echo, either one was fine. If the numbers are getting low and you want a precise number, then the MUGA would be used. Otherwise, the echo is fine.

I prefer the echo, it's easier and less invasive.

[jhandley]

Hi
I have recently switched to echos because they are less invasive. The echo picked up a small area of fluid in/around the heart (I can't remember where exactly) that the MUGAs did not. I know it wasn't there in 2001 when I had an echo to get on the taxotere trial. So this fluid is possible due to adriamycin (highly likely) or taxotere, CMF, taxol or herceptin.

I am having another echo on 2nd April so will be interested to see if the fluid has increased.
Jackie

[MCS]

I have a picky onc. He would not tolerate the echo because he wanted a number to accutarely monitor the heart.


It is not hard to do. The port can be used for MUGGAs.

MCS ( maria)

[suzan w]

My oncologist felt that the MUGA was a more accurate measure so that's what I had.

[concerned]

Thank you all for your input. Mom is feeling better and the pain left sometime Sat. She met with the dr today and found out that her thyroid showed a nodule and she will need a new cat scan next month. Trying to believe it's nothing.....

Hi,

The Muga isn't that precise either. My last MUGA was done twice; first result was 57, second was 61; and the final reading from the radiologist was 63. Tech told me it can vary by five points--mine varied by six. Also, if you have difficult veins a MUGA can be very stressful. First time, I had large black and blue marks on arm and hand.

I've had three MUGA's, and this time I'm going for an echo, mainly because my last MUGA mentioned possible right ventricle problems but couldn't be precise, as a MUGA is used mainly to view the left ventricle. My cardiologist recommended an echo so we can check the right ventricle as well as the left. Other good news about an echo, for me anyway, is I don't need an approval from my insurance.

[cherylynnie]

Grace,
I have had five muga scans throughout my treatment and when my 4th one dropped to 55 my onc sent me to see a cardiologist. I then had my first echo, which he said showed the same as the muga did, that my heart wasn't pumping as vigoriously as he would like but that I was okay. I had another muga a month later and it went up to 59, so both the onc and cardio thought that it was better.

Then I had some problem in my left arm, the side where my port was, and every needle for anything else got poked into me. It was red/purplely and slightly swollen, so I decided I didn't want any more radioactive dye going into my arm. So for my final end of treatment check I had an echo, and the cardiologist will have to read it and figure it out. I have an appointment with him on Friday. So we will see. He is a very arrogant Korean Dr. very high strung. I don't think he will be happy that I just went in for the echo, because they were asking me who ordered this and I said that my onc did, when the cardio should have been the one to order it. Well I kinda of took it in my own hands. I got my port out before my last treatment and my arm is doing a little better but not completely. So they used my mastectomy side for my last treatment, and then when I just had an excisional biopsy they used my right arm again. And it is fine. I have an apt with a rehabilitation doctor to help figure out what is wrong with my left arm.

Sorry I am rambling, but the echo is easier than the muga!

Cheryl

Dear Cheryl,

I too hate arrogant doctors, and stars. My first breast surgeon was both, and I moved on to another, after surgery. I never complained about her to anyone, least of all to her since I never got more than a few minutes of her time, but I have since discovered that she keeps asking everyone at my cancer center why I left her, including my new surgeon, who is not a star, but great nonetheless. The second surgeon, by the way, thinks it very funny that the star is canvassing everyone. The star even called me at home and left a message on my machine asking 'why?' (she has a staff of hundreds), so perhaps the arrogance is just masked insecurity. Just wanted to share!

My oncologist told me before I began chemotherpathy that although the rule is not to have needles in the affected side that if push comes to shove, it's okay. Of course, I only had two nodes removed, so that may make a difference. I haven't had to do this yet, but if and when the time comes (and it probably will), I will let them use that arm.

I hope your left arm improves very soon and that all your future echos bring good news. Let us know how it goes.

Further to Muga vs Echo. I just had an echo and my LVEF, measured three times, was 63, 61, 62, which is just about what my Muga's have been showing. The technician also looked extensively at right ventricle and the full heart, contractions, etc.,but I don't yet have the radiologist's report on that, which is my main concern. However, the technician did tell me that they don't measure right ventricle flow, as it would be too difficult to measure, and that the left is really the important measurement with respect to EF. And, finally, the echo was so much easier to do, no needles, and no approvals needed from my insurance. So echo is the way I plan to go in the future.

[Barbara2]

The following is from the current issue (Spring 2007) of the CURE magazine:

Monitoring the Heart
Patients receiving potentially cardiotoxic cancer therapy should be carefully monitored both during and after treatment. An echocardiogram (heart ultrasound) is the primary tool used to monitor heart health, but other tests may also be done, including blood tests, electrocardiograms or multiple-gated acquisition (MUGA) scans, which produce a moving image of the heart muscle.

M.D. Anderson Cancer Center's department of cardiology recently sponsored a panel discussion of oncologists and cardiologists to discuss how to best monitor a patient's heart function. Concerning the issue of whether to use non-invasive echocardiogram or time-consuming yet genearally more precise MUGA, the panel determined either imaging method was acceptable depending on the expertise of the radiologists and cardiologists at a particular cancer center.

Following treatment, survivors should have a yearly checkup to identify any long-term consequences of cancer therapy. Those at higher risk for heart complications may need more frequent monitoring.

I finally received my report from my echo (which was done in lieu of a MUGA as my last MUGA indicated that I had right ventricle hypokinesis). The echo was much easier on me (my veins were protesting) and the echo report gives more information than the MUGA did. LVEF is down some, 60% from 63%, which is fine, and all my other measurements were in the normal range. New to me though was the pronouncement that I have "prominent epicardial fat," so another thing to worry about. And how did I feed that worry?--with a large piece of iced pound cake. Tomorrow . . .

[Bev]

I asked to be switched to echo's when I saw others here were doing it. The only reason for a muga in my mind would be if you were fresh from surgery and couldn't tolerate the transducer being rubbed on your scar. I've done at least 2 of each and echo has my vote. BB