What is the severity of a 10 percent ejection fraction (EF)?

From the Guidelines

An ejection fraction (EF) of 10 percent is considered severely reduced and represents a critical cardiac condition, indicating a high risk of mortality and morbidity, as evidenced by studies such as 1 and 1. This level indicates that the heart is only pumping 10% of the blood from the left ventricle with each contraction, compared to the normal range of 50-70%. Patients with this severely reduced EF are typically diagnosed with advanced heart failure and require immediate medical attention. Treatment usually involves a combination of medications including ACE inhibitors (like lisinopril or enalapril), beta-blockers (such as carvedilol or metoprolol), diuretics (like furosemide), and aldosterone antagonists (spironolactone), as supported by guidelines such as 1. Some key points to consider in the management of patients with severely reduced EF include:

• The importance of close monitoring and lifestyle modifications, including sodium restriction
• The potential need for device therapy, such as an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT)
• The possibility of evaluating patients for advanced therapies, like left ventricular assist devices or heart transplantation, as discussed in 1
• The impact of severely reduced pumping capacity on multiple organ systems, including kidney function, liver function, and overall tissue perfusion, highlighting the need for a comprehensive approach to management. The most recent and highest quality study, 1, emphasizes the importance of classifying heart failure based on LVEF, with HFrEF defined by clinical HF syndrome with LVEF ≤40%, and highlights the need for individualized treatment approaches.

From the Research

Severity of a 10 Percent Ejection Fraction (EF)

• A 10 percent ejection fraction (EF) is considered severe left ventricular dysfunction, as it indicates that the left ventricle is only able to pump out 10% of its blood volume with each heartbeat 2.
• This condition is often associated with heart failure with reduced ejection fraction (HFrEF), which is a major public health concern with substantial morbidity and mortality 2.
• Studies have shown that patients with severe left ventricular dysfunction, including those with an EF of 10%, are at high risk of sudden death and cardiac arrest 3.
• The risk of sudden death is highest in the first 30 days after myocardial infarction among patients with left ventricular dysfunction, heart failure, or both, and each decrease of 5 percentage points in the left ventricular ejection fraction is associated with a 21% adjusted increase in the risk of sudden death or cardiac arrest with resuscitation in the first 30 days 3.
• In patients with severe aortic regurgitation, an EF of less than 50% is associated with significant left ventricular dysfunction and poor prognosis, but surgical treatment can offer a survival benefit 4.
• The presence of new left ventricular systolic dysfunction, defined as low LVEF, is associated with increased mortality in patients with severe sepsis and septic shock, but its prognostic value is limited by moderate statistical heterogeneity and underpower of the studies 5.

Clinical Implications

• Patients with a 10% EF are likely to experience significant symptoms, including dyspnea and exertional limitation, and may require aggressive medical treatment, including diuretics, beta-blockers, and disease-modifying therapies 2.
• Early implementation of strategies for preventing sudden death, such as implantable cardiac defibrillators, may be warranted in selected patients with severe left ventricular dysfunction 3.
• Surgical treatment, such as aortic valve replacement, may be beneficial in patients with severe aortic regurgitation and left ventricular dysfunction, despite the reported higher surgical mortality in this patient group 4.