Left Ventricular Ejection Fraction in Heart Failure-A Parameter to Be Discontinued?

Area of Science:

• Cardiology
• Clinical Medicine
• Medical Research

Background:

• Heart failure (HF) presents a significant global health challenge.
• Left ventricular ejection fraction (LVEF) is a cornerstone in HF diagnosis, treatment, and research.
• Current HF classification and understanding heavily rely on LVEF thresholds.

Purpose of the Study:

• To critically evaluate the advantages and current relevance of LVEF in heart failure.
• To explore the limitations and controversies surrounding the use of LVEF.
• To discuss emerging alternatives and future directions for HF classification and assessment.

Main Methods:

• Literature review and critical analysis of existing research on LVEF in heart failure.
• Examination of current international HF guidelines and their reliance on LVEF.
• Exploration of novel classification systems, systolic function metrics, imaging, and AI/ML applications.

Main Results:

• LVEF remains a fundamental metric in HF clinical trials and guideline-directed therapy.
• Growing evidence highlights LVEF's limitations in fully characterizing HF heterogeneity and prognosis.
• Alternative and complementary methods for HF assessment are under active investigation.

Conclusions:

• While LVEF has historical and clinical importance, its limitations necessitate a broader approach to HF assessment.
• Future HF classification may integrate novel biomarkers, advanced imaging, and machine learning for improved patient stratification.
• A paradigm shift beyond LVEF is likely required for comprehensive HF management and research.