Is the ef determined by the ultrasound itself or is it visually calculated? mine was 50/55 visual and 63 by the machine which is accurate?

Not exact as we wish: Ejection fraction is visually estimated by a trained cardiologist. The Echo machine does contain algorithms to make an estimate of EF, but visual estimates are usually better because they focus on the evaluation of multiple images, from many directions. If the difference between these numbers is clinically significant, your ordering doctor will tell you. Either number would be OK for most peopl