What is the significance of a normal left ventricular (LV) size, mass, and systolic function with a left ventricular ejection fraction (LVEF) of 55-60%, along with normal diastolic function?

From the Guidelines

The patient's heart is functioning normally, with an LVEF of 55-60% and normal diastolic function, indicating no need for specific heart failure management or medications, as this LVEF range is considered above the threshold for heart failure with reduced ejection fraction (HFrEF) or heart failure with mildly reduced ejection fraction (HFmrEF) 1.

Key Findings

• The left ventricle (LV) has a normal size and mass.
• The LVEF is 55-60%, which is above the threshold for HFrEF (LVEF ≤40%) and HFmrEF (LVEF 41-49%) as defined by the 2022 AHA/ACC/HFSA guideline 1.
• Diastolic function is normal, indicating proper relaxation and filling of the ventricle.

Clinical Implications

• The patient does not meet the criteria for heart failure with reduced ejection fraction (HFrEF) or heart failure with mildly reduced ejection fraction (HFmrEF) based on the LVEF range.
• The diagnosis of heart failure with preserved ejection fraction (HFpEF) typically requires an LVEF ≥50%, and while the patient's LVEF falls within this range, the absence of symptoms or objective measures of cardiac dysfunction (such as elevated natriuretic peptide levels) suggests that a diagnosis of HFpEF may not be applicable in this case 1.
• Given the normal LVEF and diastolic function, the patient's cardiovascular health is optimal from a structural and functional perspective, and no specific interventions or medications are needed based on these findings.

From the Research

Left Ventricular Size and Function

• The left ventricular (LV) size, mass, and systolic function with a left ventricular ejection fraction (LVEF) of 55-60% are within normal limits, as indicated by studies such as 2 and 3.
• Normal diastolic function is also reported, which is consistent with the findings of 2 and 3.

Reference Values for Left Ventricular Dimensions

• The study 2 provides reference values for left ventricular dimensions, systolic, and diastolic function in healthy adults from the Amazon Basin of Brazil.
• The study 3 reports on the worldwide feasibility of LV 3D echocardiography and provides size and functional measurements, including LV end-diastolic and end-systolic volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), and global circumferential strain.
• The upper limits of normality for cardiac dimensions (indexed and non-indexed) were found to be higher compared to contemporary guidelines, as reported in 2.

Left Ventricular Ejection Fraction (LVEF)

• A LVEF of 55-60% is within the normal range, as indicated by studies such as 2 and 3.
• The lower limit of normality for LVEF is around 50%, as reported in 2 and 3.

Factors Influencing Left Ventricular Size and Function

• Age, sex, and race should be considered when defining normal reference values for LV dimension and functional parameters, as reported in 3.
• The use of angiotensin-converting enzyme inhibitors and statins has been shown to have a beneficial effect on left ventricular remodeling and survival in patients with heart failure, as reported in 4 and 5.