What is a normal cardiac ejection fraction?

Normal Cardiac Ejection Fraction

A normal left ventricular ejection fraction (LVEF) ranges from 50% to 70%, with a midpoint of 60%. 1

Definition and Classification of LVEF

• LVEF is categorized according to the following ranges as defined by the American College of Cardiology/American Heart Association guidelines 1:

  • Hyperdynamic: greater than 70%
  • Normal: 50% to 70% (midpoint 60%)
  • Mild dysfunction: 40% to 49% (midpoint 45%)
  • Moderate dysfunction: 30% to 39% (midpoint 35%)
  • Severe dysfunction: less than 30%

• The lower limit of normal LVEF is generally accepted as 50%, with values below this threshold indicating some degree of left ventricular systolic dysfunction 1, 2

Measurement Considerations

• LVEF measurement varies by imaging modality, with each having its own specific range of normal values 1

• When reporting LVEF as a numerical value, the imaging modality and method of analysis (visual or quantitative) should be specified 1

• There is inherent variability in LVEF measurements, with potential differences of 5-7% between studies due to technical factors rather than actual changes in cardiac function 1

• For accurate assessment, it's important to document serial changes in size and function of the left ventricle at several points in time, rather than relying on a single measurement 1

Clinical Significance

• LVEF is a key parameter for:

  • Diagnosing heart failure (distinguishing between heart failure with reduced ejection fraction vs. heart failure with preserved ejection fraction) 3
  • Determining prognosis in various cardiac conditions 4
  • Guiding therapeutic decisions, particularly in valvular heart disease 1

• Low-normal LVEF (50-55%) in asymptomatic individuals is associated with a 3.64-fold increased risk of developing heart failure compared to those with LVEF ≥55%, highlighting the importance of the lower threshold of normal 4

• Hyperdynamic LVEF (>70%) may not always be benign, as some studies have shown increased mortality in elderly women with very high LVEF (>65%) following acute coronary syndromes compared to those with normal LVEF (55-65%) 5

Special Considerations

• Due to their hyperdynamic circulation, patients with cirrhosis typically have an ejection fraction greater than 70-75% 1

• LVEF is a continuous variable, not binary, so progressive changes in LVEF may be more clinically relevant than specific cutoff points 1

• Three-dimensional imaging methods (echocardiography, CT, CMR) may provide more accurate volume-based LVEF measurements compared to traditional two-dimensional methods that rely on geometric assumptions 1

• In patients with normal LVEF but symptoms of heart failure, diastolic dysfunction should be considered as a potential cause (heart failure with preserved ejection fraction) 3, 6