What is a normal left‑ventricular ejection fraction (EF) for a 40‑year‑old compared with a 50‑, 60‑, and 70‑year‑old?

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Last updated: September 27, 2026 • View editorial policy

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Normal Ejection Fraction Does Not Vary Significantly by Age

Normal left ventricular ejection fraction (LVEF) is essentially the same across all adult age groups from 40 to 70+ years, ranging from 53-73% regardless of age. 1

Key Guideline-Based Reference Values

The 2015 ASE/EACVI guidelines provide the definitive answer: EF is not significantly related to gender, age, or body size 1. The normal reference value using 2D echocardiography with the biplane method of disks is:

  • Mean: 63 ± 5%
  • Normal range: 53-73% for all adults aged >20 years 1

Gender-Specific Cutoffs (More Relevant Than Age)

While age doesn't matter, gender does:

  • Men: Normal range 52-72% (abnormal if <52%) 1
  • Women: Normal range 54-74% (abnormal if <54%) 1

The 2019 European CMR guidelines confirm this age-independence, showing normal EF of 57-77% for both men and women aged 20-80 years 2

Why This Matters Clinically

An LVEF <50% is highly unlikely to be normal at any age 3. Recent meta-analysis data (2026) shows:

  • Lower limit of normal: ~53% for women, ~52% for men
  • Probability that LVEF <50% represents normal function: <5% across all age groups 3

Common Pitfall to Avoid

Do not attribute reduced ejection fraction to "normal aging." While older studies from the 1980s suggested age-related decline in exercise response 4, contemporary guidelines based on larger population studies demonstrate that resting LVEF remains stable across decades 1. The confusion arose from exercise studies, not resting measurements.

Practical Application Algorithm

For any patient aged 40-70+ years:

  1. Use the same normal range: 53-73% (or gender-specific cutoffs above)
  2. LVEF 52-74%: Normal (no age adjustment needed)
  3. LVEF 41-51%: Mildly abnormal 1
  4. LVEF 30-40%: Moderately abnormal 1
  5. LVEF <30%: Severely abnormal 1

Minor Ethnic Considerations

Individuals of Asian origin may have 2-3 percentage points higher LVEF, with lower normal limits of 54% for women and 53% for men 3, but this is a minor adjustment compared to the lack of age effect.

The bottom line: Use identical ejection fraction reference ranges for your 40,50,60, and 70-year-old patients. Age-based adjustment is not supported by current evidence and may lead to underdiagnosis of systolic dysfunction in older adults.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.