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Related Concept Videos

Pathophysiology of Heart Failure01:17

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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[A critical analysis of ejection fraction].

Peter Lm Kerkhof1, Rienzi Díaz-Navarro2, Guy R Heyndrickx3

  • 1Dept. Radiologyand Nuclear Medicine, University Medical Centers, Amsterdam, Netherlands.

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Summary

Ejection fraction (EF) is a misleading measure of cardiac function. End-systolic volume (ESV) is a more logical metric for analyzing ventricular mechanics, despite EF's widespread clinical use.

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Area of Science:

  • Cardiology
  • Physiology
  • Medical Imaging

Background:

  • Ejection fraction (EF) is a widely used clinical marker for cardiac function.
  • However, EF's interpretation is ambiguous due to its dimensionless nature and reliance on end-systolic volume (ESV) and end-diastolic volume (EDV).

Purpose of the Study:

  • To analyze the role of ESV as a fundamental variable in ventricular mechanics.
  • To compare the clinical utility of ESV with the commonly used EF.
  • To critically discuss the historical and physiological basis for EF's prominence.

Main Methods:

  • Physiology-based mathematical analysis of cardiac mechanics.
  • Analysis of data from angiocardiography, echocardiography, and cardiac magnetic resonance imaging.
  • Historical review of the emergence of EF as a clinical metric.

Main Results:

  • A simple, non-linear association exists between EF and ESV.
  • EF approaches 100% with small ESV and decreases towards zero with large ESV.
  • EF's popularity is attributed to its correlation with ESV, rather than inherent physiological significance.

Conclusions:

  • EF is a potentially misleading metric for cardiac function.
  • ESV is proposed as a more logical and fundamental metric for ventricular function analysis.
  • The widespread use of EF may be a result of historical serendipity rather than robust physiological justification.