MRI Follow up Confusion on EF

Second post as I have more info from follow up versus just me looking at MRI results and asking this forum what’s up.

Just to put it first because others asked, yes I’m on TRT and HGH. But no steroid abuse at all. I’m exact same size I was as a teenager (actually 10 pounds less). 5’10, 225lbs, very low body fat.

Zero symptoms. Been seeing cardiologists for years because of family history to be safe. About 4 years ago finally had to go on BP meds. Was borderline up until then but some serious insomnia and life stress pushed my BP up and had to start meds. But no symptoms even when I had super high BP.

50s. I do eat primarily red meat (organic grass fed), eggs, salmon and organic fruit. So cholesterol numbers have always been high but old cardiologist said not the bad ones and didn’t want me on statins and said I was metabolically healthy. That it’s not about cholesterol and when he did check my CAC was zero 4 years ago.

Latest appointment “Your MRI looks good,
Makes no sense your EF dropped from 60% on the echo to 40% on MRI? Do you feel differently or have any symptoms?” Nope.

Cardiac MRI had to be redone twice on two different machines (3.0 and 1.5? Something or other different numbers on machines). Staff Said it was hard to get clear pictures on first machine because too low of body fat and so much muscle. I was in that thing for 2 hours when they said it would be an hour. And that was challenging mentally for sure.

So had to repeat it on different machine… Then MRI shows no scarring or damage at all. But ejection fraction only 40% when a year before an echo had 60%.

“Dilated left and right ventricles with mild to moderate global reduction of left ventricular systolic function, left ventricular ejection fraction 40%. Right ventricular ejection fraction 37%. No evidence for late gadolinium enhancement. No evidence for infiltrative cardiomyopathy. Normal biatrial size. “

4 years ago calcium scan was zero.

Now have to repeat another echo and CT scan with contrast.

Aspects of “enlarged heart” on initial echo last year made initial cardiologist and associated primary care seem to get all alarmed and asking if I’m short of breath or having fatigue or other symptoms and I’m like none.

Then other doctors I consulted just because those two made me scared are like yea lifelong athletes have larger hearts, but bigger pipes can be better even if you eventually have buildup. And whatever numbers of mine did show the “inside of the pipes” are normal or bigger than normal, so not restricted… but they freaked me out over it initially. Hence wanting the MRI.

Current cardiologist also wants me on statin due to cholesterol. Former cardiologist before passing away and other doctors I consulted were against statins as my blood sugar, inflammation, metabolic stuff all excellent. So there is also the confusion why some doctors are “statins aren’t the answer or really necessary and have their own issues” versus “high cholesterol = immediately prescribe statins and stop eating red meat”

Don’t know if HRV ties in. Since I’ve had an Oura Ring for 3.5 years or so, even when fit my HRV is really low. But I sleep like crap. My sleep scores usually are bad or moderate, daytime stress and HRV usually very good as in restored, relaxed or engaged most of time with little stress.