From the Guidelines
A normal left ventricular (LV) ejection fraction is 50% to 70%.
Definition of Normal LVEF
- The American College of Cardiology/American Heart Association guidelines define a normal left ventricular ejection fraction (LVEF) as ≥50% 1.
- The 2008 key data elements and definitions for cardiac imaging report provides a more specific range for normal LVEF, categorizing it as 50% to 70% (midpoint 60%) 1.
Key Points
- LVEF is an important factor in the classification of heart failure (HF) and its management.
- HF with preserved EF (HFpEF) is defined as LVEF ≥50% 1.
- The diagnosis of HFpEF and HF with mildly reduced EF (HFmrEF) can be challenging and requires additional objective measures of cardiac dysfunction.
- Elevated natriuretic peptide levels and noninvasive/invasive hemodynamic measurements can support the diagnosis of HFmrEF and HFpEF 1.
From the Research
Definition of Normal Left Ventricular Ejection Fraction
- A normal left ventricular ejection fraction (LVEF) is generally considered to be 55% or higher, as stated in guidelines 2.
- However, some studies suggest that LVEF can be considered normal in the range of 50-55%, which is referred to as low normal LVEF 2.
- The lower limit of normal for LVEF at rest is considered to be 50% according to a study that analyzed pooled data from 1200 normal subjects 3.
Factors Influencing Left Ventricular Ejection Fraction
- Age, sex, and other factors can influence LVEF, with men tend to have higher LVEF than women, and younger subjects tend to have higher LVEF than older subjects 3.
- The optimal LVEF cut-off for risk stratification for primary prevention of sudden cardiac death early after myocardial infarction is unknown, but a cut-off of ≤40% is often used 4.
Relationship between Left Ventricular Ejection Fraction and Cardiovascular Outcomes
- Lower LVEF is associated with increased risk of cardiovascular events, including congestive heart failure and all-cause mortality 2, 5.
- The relationship between LVEF and cardiovascular outcomes is complex, and other factors such as ischemic aetiology and history of heart failure can influence the prognostic value of LVEF 5.
- A study found that LVEF had a U-shape association with future congestive heart failure risk, with both low and high LVEF being associated with increased risk 2.