Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure

Area of Science:

• Cardiology
• Medical Diagnostics

Background:

• Left ventricular ejection fraction (LVEF) is a primary metric for heart failure diagnosis and management.
• LVEF's predictive value for adverse outcomes diminishes as it approaches normal ranges.
• Current LVEF assessment relies on geometric assumptions and is influenced by loading conditions, limiting its reproducibility and scope.

Purpose of the Study:

• To highlight the limitations of LVEF as a sole predictor of risk in heart failure.
• To propose a more comprehensive assessment strategy for evaluating left ventricular function and patient risk.
• To introduce an integrative approach for improved heart failure risk prediction.

Main Methods:

• Review of existing literature on LVEF and its limitations in heart failure.
• Conceptualization of an integrative assessment model.
• Identification of key parameters beyond LVEF for risk stratification.

Main Results:

• LVEF is preload- and afterload-dependent, moderately reproducible, and influenced by comorbidities like hypertension, diabetes, and renal function.
• A single LVEF measurement provides limited risk information, especially in patients with preserved or near-normal LVEF.
• An integrative approach incorporating biventricular function, geometry, atrial size, valvular function, and clinical/biomarker data offers a more complete risk profile.

Conclusions:

• Relying solely on LVEF for heart failure risk assessment is insufficient due to its inherent limitations.
• A comprehensive evaluation integrating imaging and non-imaging parameters is necessary for accurate risk prediction in heart failure.
• The proposed integrative approach promises enhanced understanding and management of heart failure patients.