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Updated: Aug 6, 2026
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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Cardiology without ejection fraction
Peter L M Kerkhof1, Rienzi A Diaz-Navarro2, Neal Handly3
1Research Fellow, Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
The British Journal of Cardiology
|July 17, 2026
Summary
Ejection fraction (EF) is a popular but conceptually flawed metric for assessing heart pumping capacity. This review explores its limitations and proposes alternative methods using standard measurements.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Statistics
Background:
- Ejection fraction (EF) is widely used to evaluate ventricular and atrial pumping capacity.
- Despite its ease of calculation and perceived reflection of performance, EF has conceptual weaknesses.
Purpose of the Study:
- To critically analyze the conceptual limitations and statistical irregularities of ejection fraction (EF).
- To explore the reasons behind the traditional popularity of EF in cardiology.
- To propose alternative metrics for assessing cardiac function.
Main Methods:
- Conceptual analysis of the ejection fraction (EF) metric.
- Graphical representation of EF's dependence on end-systolic volume (ESV) and end-diastolic volume (EDV).
- Review of existing literature on EF's application and limitations.
Main Results:
- EF's numerical value is strictly determined by ESV and EDV, highlighting a mathematical dependency.
- The study identifies intrinsic shortcomings and statistical irregularities associated with EF.
- Misleading attractiveness of EF is discussed in the context of its widespread use.
Conclusions:
- Ejection fraction (EF) is conceptually suboptimal for assessing cardiac performance.
- Alternative methods exist that offer logical improvements without requiring additional data.
- A re-evaluation of EF's role in cardiology is warranted.
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