Effects of massive ascites on measurement of cardiac ejection fraction via multi-gated acquisition (MUGA) scanning.

A patient with massive ascites secondary to ovarian carcinoma was found to have a low cardiac ejection fraction as measured by multi-gated acquisition (MUGA) scanning. Because of this low measurement, she was not treated with Adriamycin for fear of cardiac toxicity. Because the MUGA was felt to be incorrect, we performed simultaneous echocardiography and then repeated the MUGA scan after removal of 9000 cc of ascites fluid. The echocardiogram showed an ejection fraction in excess of 50% and the MUGA performed after paracentesis revealed an ejection fraction of 63% (an increase of 133%). We conclude that the MUGA is an inaccurate way to assess cardiac ejection fraction in the presence of massive ascites and that other ways to assess cardiac function should be used when there is need to determine such function in patients with massive ascites.