Is an ejection fraction (EF) of 55-60 percent considered normal?

Normal Ejection Fraction Range

Yes, an ejection fraction (EF) of 55-60% is considered normal. 1 According to current guidelines, a normal left ventricular ejection fraction ranges from 50% to 70%, with 60% being the midpoint of the normal range.

Classification of Ejection Fraction

• Normal EF is defined as 50% to 70% 1
• Hyperdynamic EF is greater than 70% 1
• Mildly diminished/reduced EF is 40% to 49% 1, 2
• Moderately diminished/reduced EF is 30% to 39% 1
• Severely diminished/reduced EF is less than 30% 1

Clinical Significance

• Heart failure is categorized based on EF values:

  • Heart failure with reduced EF (HFrEF): LVEF ≤40% 3, 4
  • Heart failure with mildly reduced EF (HFmrEF): LVEF 41-49% 3, 2
  • Heart failure with preserved EF (HFpEF): LVEF ≥50% 3, 5

• The European Society of Cardiology and American College of Cardiology recognize these distinct categories because treatment approaches differ based on EF classification 5, 4

Sex-Based Differences

• There are notable sex differences in normal EF ranges, with women typically having higher normal values 4
• Some experts suggest normal EF should be defined as ≥55% in men and ≥60% in women 4
• The European Association of Cardiovascular Imaging provides sex-specific reference ranges in their consensus documents 3

Measurement Considerations

• EF is calculated as: (End-diastolic volume - End-systolic volume)/End-diastolic volume × 100 1
• Quantitative measurement is preferred over qualitative assessment 1
• Various imaging modalities can measure EF, including:
  • Echocardiography (most common)
  • Cardiac MRI (gold standard)
  • Radionuclide ventriculography
  • Contrast ventriculography 1

Clinical Context

• An EF of 55-60% indicates normal left ventricular systolic function 3, 1
• This range is well within normal limits and suggests good cardiac contractility 3
• Patients with normal EF may still develop heart failure (HFpEF) due to diastolic dysfunction rather than systolic dysfunction 5, 6
• HFpEF accounts for approximately 50% of all heart failure cases 5, 6

Important Caveats

• EF measurements can vary between imaging modalities and interpreters 1
• A single EF measurement may not be adequate for clinical decision-making, particularly for values near the borderline ranges 1
• EF should be interpreted in the context of other clinical findings and cardiac parameters 3
• Normal EF does not exclude cardiac disease, as diastolic dysfunction can occur with preserved EF 5, 6

In summary, your ejection fraction of 55-60% falls well within the normal range, indicating normal left ventricular systolic function.