This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Ejection fraction (EF)

Authoring team

Left ventricular ejection fraction is usually determined by echocardiography or radiographic ventriculography.

The ejection fraction is:

stroke volume = (end diastolic volume - end systolic volume)

ejection fraction = stroke volume / end diastolic volume

The ejection fraction is a good predictor of longevity in patients with heart failure but does not correlate with symptomatic limitation.

Systolic dysfunction

  • LV (left ventricular) systolic dysfunction is assessed using the EF (ejection fraction) (the percentage of the end diastolic volume ejected during systole)
    • in most cases, this is estimated by eye from all the available echo views
    • normal ejection fraction is 50%-80%, but values as low as 5% are compatible with life (end-stage heart failure)

    • what is an abnormal left ventricular ejection fraction?
      • current ACCF/AHA guidelines classify patients with a left ventricular ejection fraction (LVEF) of >=50% as having a preserved ejection fraction (1), and previous studies have found that asymptomatic patients with lower LVEF are at greater risk of developing HF
        • in a study of patients with untreated hypertension, an LVEF of <50% was associated with a 10-fold increased risk of incident HF, compared with patients with an LVEF of >50% (2)
        • the MESA (Multi-Ethnic Study of Atherosclerosis) study, an LVEF of <50% was associated with a 12-fold increased risk of HF and 3.5-fold increased risk of all-cause mortality (3)

    • classifications of heart failure using LVEF
      • Heart failure definition
        • Heart Failure with
          • Reduced ejection fraction (HFrEF) - LVEF<40%

          • Mid-range ejection fraction (HFmEF) - LVEF 40- 49%

          • Preserved ejection fraction (HFpEF) - LVEF>=50%

      • Heart failure definition
        • Systolic impairment and EF
          • Severe reduction - EF <35%

          • Moderate reduction - EF 35-39%

          • Mild reduction- 40-49%

          • Normal-EF>=50%

Diastolic dysfunction

  • if there is a normal LV ejection fraction in the presence of the heart failure syndrome leads to consideration of a diagnosis of diastolic dysfunction
  • in diastolic dysfunction typical echo findings in diastolic dysfunction are normal LV cavity size, thickened ventricle, and reversed E/A ratio

The E/A ratio

  • when flow across the MV is assessed with PW Doppler, two waves are characteristically seen
    • represent passive filling of the ventricle (early [E] wave)
    • active filling with atrial systole (atrial [A] wave)

    • classically, the E-wave velocity is slightly greater than that of the A wave
      • however, in conditions that limit the compliance of the LV, two abnormalities are possible:
        • reversal
          • the A wave is greater than the E wave
          • indicates slow filling caused by older age, hypertension, left ventricular hypertrophy (LVH), or diastolic dysfunction
        • exaggeration of normal
          • a tall, thin E wave with a small or absent A wave
          • indicates restrictive cardiomyopathy, constrictive pericarditis, or infiltrative cardiac disease (eg, amyloidosis)

Reference:

  • Yancy CW, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 2013; 62: e147-e239
  • Verdecchia P et al.i Asymptomatic left ventricular systolic dysfunction in essential hypertension: prevalence, determinants, and prognostic value Hypertension 2005; 45:412-418
  • Yeboah J et al. Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA) Circulation 2012;126:2713-2719
  • Walsh J. Nottinghamshire Heart Failure Traffic Light Guidelines. Nottingham University Hospitals NHS Trust (Accessed May 19th 2018)

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.