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Book

Left Ventricular Ejection Fraction

Pirbhat Shams, Amandeep Goyal  1 , Amgad N. Makaryus  2
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
.
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Book

Left Ventricular Ejection Fraction

Pirbhat Shams et al.
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Excerpt

The left ventricular ejection fraction (LVEF) is a fundamental measure of left ventricular (LV) systolic function, serving as a surrogate marker of myocardial contractility. LVEF is widely recognized as a crucial parameter for assessing cardiac function and is one of the strongest predictors of cardiovascular outcomes and events across all genders and age groups.

Quantifying and reporting LVEF is a fundamental aspect of assessing cardiac structure and function using modalities such as echocardiography, nuclear ventriculography, cardiac magnetic resonance imaging (CMR), and cardiac computed tomography (CT). Precise measurement of LVEF is crucial for the diagnosis and management of ischemic heart disease, valvular and structural or congenital heart conditions, as well as systemic diseases with cardiac involvement.

LVEF also plays a pivotal role in determining eligibility for device therapies in patients with arrhythmias or those at risk for sudden cardiac death. Over the years, several imaging modalities have been developed to quantify LVEF, with 2-dimensional (2D) echocardiography remaining the most widely used method due to its accessibility and cost-effectiveness.

LVEF is the fraction of blood ejected from the left ventricle during systole (stroke volume [SV]) relative to the volume of blood present at the end of diastole (end-diastolic volume [EDV]). LVEF is expressed as a percentage and represents the proportion of blood pumped out of the left ventricle with each heartbeat.

Stroke volume (SV) is calculated as the difference between EDV and end-systolic volume (ESV). Accordingly, LVEF is determined using the following formula:

LVEF (%) = (SV/EDV) × 100 = [(EDV−ESV)/EDV] × 100

According to the American Society of Echocardiography and the European Association of Cardiovascular Imaging, the reference ranges for LVEF obtained by 2D echocardiography are provided in Table 1 below.

The American College of Cardiology classifies heart failure into distinct categories based on left ventricular ejection fraction LVEF, which helps guide treatment decisions and provides insight into disease severity and underlying cardiac function in affected patients. The categories include:

  1. Heart failure with preserved ejection fraction (HFpEF): LVEF ≥50%

  2. Heart failure with reduced ejection fraction (HFrEF): LVEF ≤40%

  3. Heart failure with mildly reduced ejection fraction (HFmrEF): LVEF 41% to 49%

  4. Heart failure with improved ejection fraction (HFimpEF): LVEF ≥40% (previously ≤40%)

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Conflict of interest statement

Disclosure: Pirbhat Shams declares no relevant financial relationships with ineligible companies.

Disclosure: Amandeep Goyal declares no relevant financial relationships with ineligible companies.

Disclosure: Amgad Makaryus declares no relevant financial relationships with ineligible companies.

References

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