From the Guidelines
An ejection fraction (EF) of 53% is indicative of preserved systolic function, but may be associated with diastolic dysfunction, which cannot be determined solely by EF measurement. Systolic function refers to the heart's ability to contract and pump blood out to the body, which is directly measured by the ejection fraction. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1, a normal EF range is typically considered to be ≥50%, so 53% falls within normal limits. This means the heart is pumping approximately 53% of the blood volume contained in the left ventricle with each contraction.
Some key points to consider in this context include:
- The guideline defines heart failure with preserved ejection fraction (HFpEF) as an LVEF ≥50% 1
- Diastolic dysfunction, on the other hand, relates to problems with the heart's ability to relax and fill with blood between beats, which is not directly measured by the ejection fraction 1
- Diastolic dysfunction can exist even with a normal EF, and would require additional measurements such as E/A ratio, deceleration time, or tissue Doppler imaging for proper diagnosis
- The diagnosis of HFpEF can be challenging and requires objective measures of cardiac dysfunction, such as elevated natriuretic peptide levels or noninvasive/invasive hemodynamic measurement 1
It's essential to note that while this EF value is technically normal, it's on the lower end of normal, so regular cardiac follow-up would still be advisable, especially if there are any symptoms or risk factors for heart disease. Furthermore, the trajectory of LVEF over time and the cause of heart failure are crucial in evaluating patients with heart failure 1.
From the Research
EF of 53% Classification
- An EF of 53% can be classified as systolic dysfunction, as it is below the normal range of 55-70% 2.
- According to the study by 2, 90% of subjects had an LVEF between 53% and 71%, indicating that an EF of 53% is at the lower end of the normal range.
- However, it is essential to consider that EF is just one measure of cardiac function, and other factors such as infarct size, end-systolic volume index, and clinical outcomes should also be taken into account 3.
Comparison with Other Studies
- A study published in 3 found that infarct size was a stronger predictor of outcomes than left ventricular ejection fraction or end-systolic volume index, suggesting that EF alone may not be sufficient to determine the severity of cardiac dysfunction.
- Another study 4 found that right ventricular ejection fraction <20% was an independent predictor of mortality in older systolic heart failure patients, highlighting the importance of considering multiple measures of cardiac function.
Clinical Implications
- The classification of an EF of 53% as systolic dysfunction has significant clinical implications, as it may indicate a higher risk of adverse outcomes and require more aggressive treatment 2, 3.
- However, the management of heart failure with preserved ejection fraction (HFpEF) is complex and requires a comprehensive approach, including the use of novel therapeutic classes such as sodium-glucose cotransporter 2 inhibitors and non-steroidal mineralocorticoid receptor antagonists 5.