The Present and Future
JACC State-of-the-Art Review
Ejection Fraction Pros and Cons: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2018.08.2162Get rights and content
Under an Elsevier user license
open archive

Abstract

Ejection fraction (EF) reflects both cardiac function and remodeling, and is widely recognized as a valuable diagnostic and prognostic tool. Its use in a variety of settings, ranging from heart failure and myocardial infarction to valvular heart disease, has made it a cornerstone of modern cardiology, pervading guidelines and practice. However, the development of the test was in another era, with younger patients and a lower prevalence of heart failure with preserved EF. The performance expectations of EF in the current era are also demanding—in relation to detection of subclinical LV dysfunction, and especially relating to recognition of changes in LV function on sequential testing—for example in patients taking cardiotoxic drugs. This review discusses whether the impressive evidence base for EF justifies its ongoing use in the context of newer markers of LV function, and the sophisticated questions posed by modern cardiology.

Key Words

ejection fraction
heart failure
myocardial infarction
strain
valvular heart disease

Abbreviations and Acronyms

2D
2-dimensional
2DE
2-dimensional echocardiography
3D
3-dimensional
3DE
3-dimensional echocardiography
AR
aortic regurgitation
AS
aortic stenosis
CI
confidence interval
CMR
cardiac magnetic resonance
EDV
end-diastolic volume
EF
ejection fraction
ESV
end-systolic volume
GLS
global longitudinal strain
HF
heart failure
HFmrEF
heart failure with midrange ejection fraction
HFpEF
heart failure with preserved ejection fraction
HFrecEF
heart failure with recovered ejection fraction
HFrEF
heart failure with reduced ejection fraction
ICD
implantable cardioverter-defibrillator
LV
left ventricle/ventricular
LVEF
left ventricular ejection fraction
MI
myocardial infarction
MR
mitral regurgitation
RV
right ventricle/ventricular
SBHF
stage B heart failure

Cited by (0)

Dr. Marwick has received research support from General Electric Medical Systems.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.