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Pathophysiology of Heart Failure

Pathophysiology of Heart Failure

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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Cardiac imaging studies encompass a wide range of noninvasive and minimally invasive techniques designed to visualize the heart's structure and function in detail. One such technique is echocardiography, which uses high-frequency ultrasound waves to produce detailed images of the heart, known as echocardiograms.
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...

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Updated: Jul 2, 2025

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Published on: October 28, 2020

Left ventricular ejection fraction: clinical, pathophysiological, and technical limitations.

Federico Vancheri¹, Giovanni Longo², Michael Y Henein³

¹Department of Internal Medicine, S.Elia Hospital, Caltanissetta, Italy.

Frontiers in Cardiovascular Medicine

|February 22, 2024

Summary

This summary is machine-generated.

Left ventricular ejection fraction (LVEF) is widely used but has limitations in assessing heart function. This review explores LVEF

Keywords:

aortic regurgitation aortic stenosis echocardiography implantable cardioverter defibrillator left ventricular ejection fraction mitral regurgitation

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Last Updated: Jul 2, 2025

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

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Published on: October 28, 2020

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography

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Published on: February 14, 2017

Area of Science:

Cardiology
Echocardiography
Cardiovascular Physiology

Background:

Left ventricular ejection fraction (LVEF) is a cornerstone in cardiovascular guidelines for risk stratification and treatment decisions in heart failure (HF).
Current guidelines rely heavily on LVEF for critical choices like valve replacement timing and implantable cardioverter-defibrillator selection.
However, LVEF is a global measure affected by loading conditions, geometry, and image quality, leading to significant variability.

Purpose of the Study:

To critically analyze the clinical, pathophysiological, and technical limitations of LVEF in cardiovascular disease.
To highlight how LVEF may not accurately reflect myocardial contractile function despite its widespread use.
To discuss the implications of LVEF variability and limitations in guiding patient management.

Main Methods:

This review synthesizes existing literature on LVEF.
It examines the pathophysiological basis of LVEF measurement and its determinants.
Clinical and technical factors influencing LVEF accuracy are analyzed.

Main Results:

LVEF reflects global cavity volume changes, not direct myocardial contractility, and can be normal even with impaired myofibril function.
Subtle myocardial ischemia may be masked by compensatory mechanisms of other myocardial fiber layers, preserving LVEF.
The dynamic nature of heart failure and interventional outcomes can alter LVEF, impacting its reliability for treatment guidance.

Conclusions:

LVEF possesses inherent limitations that challenge its role as a sole determinant for critical cardiovascular decisions.
Understanding these limitations is crucial for accurate patient assessment and effective therapeutic strategies in cardiovascular pathologies.
Alternative or complementary methods may be needed to better assess systolic function and guide management in complex cardiovascular conditions.