Safe Muga Score

[Patb]

To all who know a lot more than I, what is a safe Muga score. I had 4 A/C with
a muga score of 72, which they said was probably an error and not that high.
Then before Herceptin started, my Muga was 58, and then after 3 months of Herceptin, it was 55 but the Dr. said still ok for Herceptin. I came to Fla for the
winter and the Dr. said ok for now but would like to do an echo in a few weeks.
Can you compare an echo with a muga and what is a good score for an echo.
There is so much to worry about and of course, we all need our heart.
patb

Diagnosed in June, Stage I, No Nodes, Grade 3, ER+PR-, Her2 positive, 4 A/C's
33 Rads for Lumpectomy, and now Herceptin every two weeks. Thanks

[skeetur]

From the Mayo Clinic:

http://www.mayoclinic.com/health/ejection-fraction/AN00360

The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat. This measures the capacity at which your heart is pumping.
Because the left ventricle is the heart's main pumping chamber, ejection fraction is usually measured only in the left ventricle (LV). A normal LV ejection fraction is 55 percent to 70 percent.

[Grace]

Yesterday, I had my third MUGA scan (the first was prior to starting chemo and herceptin in August (59%), the second three months later, in November, (64%), and the third yesterday (57% and 61%). My LVEF, from an echo doppler done last March before cancer was diagnosed, was 68%.

I was concerned about the lower reading (57%) and the technician performing the test told me that he himself has an LVEF of only 55%--and no known heart disease. When he spoke to one of the cardiologists at the center for which he works, the answer was, if it's normal, it's normal. That is, stop worrying.

In my own research, I found that two conditions are often used as a basis to stop herceptin: if LVEF (1) drops ten points from baseline and (2) LVEF is under 50%. In the end, it's a decision between doctor and patient.

Hope this helps.

[Hopeful]

I, too, have had questions about MUGA's and Herceptin. My pre-Herceptin MUGA was 74. After 3 months of Herceptin, it was down to 64. I have been told it is important to have all your MUGAs at the same facility, as there are different software programs in use at different facilities, which may not give a good head-to-head comparison of the rates. The tech where I go said the first one was likely high, and that they are not as particular with the baseline tests as they expect everyone to be normal. After the 64 reading, my onc ordered another MUGA 6 weeks later that was 60. I asked him if we had to stop, but he said as long as the test came back "normal," there was no problem; and added "this isn't a terribly accurate test". (Well, if that is the case, why do we use it?) and said that heart damage from Herceptin in patients who have not had chemotherapy is extremely rare. I asked my internist (who referred me to the onc) and he said for my age (53) 60 was an excellent score, and not to worry. I am supposed to have another MUGA in 3 weeks (6 weeks after the last one). If it goes down a lot on this one, the onc mentioned involving a cardiologist and getting echoes, which sounds responsible to me. I started taking COQ10 after the last one, to see if that would help the score, and I am very curious what the next test will show.

As long as the score is over 50 and the patient has no symptoms, I think most oncs continue to give Herceptin. From what I have read, the presence of symptoms is more of a reason to stop regardless of the score (i.e., symptoms + normal score vs. no symptoms and low score).

Hopeful

[tousled1]

I get echocardiograms every 3 months and my oncologist told me if my LVEF drops to 50 or below that I will be taken off Herceptin. Usually if you have a problem and go off Herceptin your LVEF will go back up. Some doctors order MUGAs and others the echocardiogram. I think it's the oncologist's personal choice. It is important that you have the test done at the same facility -- just like all your MRIs, bone scans, PET/Ct scans. That way there is something they can compare your results with.

[MJo]

I don't have any medical training, but I can tell you my experience. My doctor told me that since I am stage 1, node neg, he would always try to balance risk of recurrence with risks of treatment. Before A/C, my muga was 70. It dropped to 59, then went up to 62, and down to 54. Doctor advised stopping Herceptin due to 16 point drop (70 to 54). By then I had nine months of Herc., and felt comfortable stopping. In Europe there is a study of 5000 women with the goal of proving that 6 months of Herc. is as effective at 12. If you are at 58 and you've had three months of Herc, I hope you will try to get in at least 3 more months of the drug.