Heart failure and left ventricular ejection fraction: a necessary but imperfect partnership
Related Experiment Video
Updated: Jan 16, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Alberto Palazzuoli1, Gaetano Ruocco2,3, Andrew P Ambrosy4,5
1Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Viale Bracci 12, 53100, Siena, Italy. palazzuoli2@unisi.it.
Insights
Left ventricular ejection fraction (LVEF) is widely used but may not fully assess heart failure. A comprehensive approach including congestion and right ventricular function offers better risk assessment.
Area of Science:
- Cardiology
- Cardiac Imaging
- Heart Failure Management
Background:
- Left ventricular ejection fraction (LVEF) is the standard metric for assessing systolic function in heart failure (HF).
- Echocardiography enables practical, rapid LVEF measurement, leading to its widespread clinical and research use.
- Current guidelines recommend longitudinal LVEF assessment for monitoring HF progression and treatment response.
Purpose of the Study:
- To evaluate the limitations of serial LVEF assessment in heart failure.
- To propose an alternative, comprehensive strategy for risk stratification and management in HF patients.
- To highlight the importance of parameters beyond LVEF for accurate cardiac assessment.
Main Methods:
- Review of current literature and clinical consensus statements on LVEF in heart failure.
- Discussion of the limitations of LVEF in reflecting overall cardiac status.
- Proposal of an alternative assessment strategy incorporating congestion, right ventricular function, and myocardial damage.
Main Results:
- Evidence supporting the benefit of serial LVEF assessment for risk stratification or management guidance in HF is limited.
- LVEF alone may not accurately represent overall cardiac function, neglecting diastolic function, ventricular size, and valvular/right ventricular function.
- A comprehensive approach offers more robust diagnostic and prognostic information.
Conclusions:
- Shifting from sole reliance on serial LVEF to a multifaceted assessment is proposed for improved heart failure management.
- Incorporating assessment of congestion, right ventricular function, and myocardial damage provides a more complete picture of patient risk.
- This comprehensive strategy aims to enhance diagnostic accuracy and prognostic value in heart failure.
Abstract:
The left ventricular ejection fraction (LVEF) is the most commonly used index to assess left ventricular systolic function and guide management in patients with heart failure (HF). This is largely due to the widespread availability of echocardiography, its practicality, rapid scan time, ease of measuring left ventricular (LV) volumes, and its extensive application in both clinical practice and research. Accordingly, a recent joint clinical consensus statement from the Heart Failure Association (HFA) and the Heart Failure Society of America (HFSA) recommends that LVEF be evaluated longitudinally to assess disease trajectory, natural history, and response to treatment in patients with heart failure (6). However, there is little, if any, evidence that serial LVEF assessment improves risk stratification or guides management in HF. Notably, LVEF may not accurately reflect overall cardiac function. While it is commonly used as a measure of systolic function, LVEF does not fully capture the status of the heart. Other parameters-such as diastolic function, ventricular size, valvular function, and right ventricular function-also play important roles in determining patient risk. This paper proposes an alternative strategy, shifting from serial LVEF evaluation to a more comprehensive approach that includes assessment of congestion, right ventricular function, and structural myocardial damage to provide more robust diagnostic and prognostic information.
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