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

Area of Science:

• Cardiology and Cardiovascular Diseases
• Cardiac Imaging and Diagnostics

Background:

• Ejection fraction (EF) is a fundamental metric in cardiology, crucial for diagnosing and managing various heart conditions like heart failure and myocardial infarction.
• The traditional development of EF assessment predates current patient demographics and the rising prevalence of heart failure with preserved ejection fraction (HFpEF).

Purpose of the Study:

• To critically evaluate the continued relevance and justification of using ejection fraction (EF) in modern cardiology.
• To assess the performance of EF against newer biomarkers for left ventricular (LV) function, especially in contemporary clinical scenarios.

Main Methods:

• This is a review article, synthesizing existing literature and clinical guidelines on ejection fraction.
• The review analyzes the historical context, current applications, and limitations of EF in light of evolving cardiovascular medicine.

Main Results:

• EF is a well-established tool but faces challenges in detecting subclinical LV dysfunction and subtle changes in sequential testing.
• The demands on EF have increased, particularly for monitoring patients on cardiotoxic therapies and those with HFpEF.

Conclusions:

• The review questions whether the extensive evidence supporting EF adequately addresses the sophisticated diagnostic needs of modern cardiology.
• It highlights the need to consider newer markers of LV function alongside EF to meet current clinical expectations.