What is a normal ejection fraction (EF) on an echocardiogram?

Normal Ejection Fraction on Echocardiogram

Definition of Normal Ejection Fraction

• A normal left ventricular ejection fraction (LVEF) ranges from 50% to 70%, with a midpoint of 60% according to current American College of Cardiology/American Heart Association guidelines. 1
• The European Society of Cardiology defines normal LVEF as 53-73% for adults over 20 years of age. 2
• Using the biplane method of disks, the American College of Cardiology recommends that normal LVEF is 63 ± 5%. 2
• For 3D echocardiography, normal LVEF values are >54% for men and >57% for women. 2

LVEF Classification

• LVEF is classified into the following categories:
  • Hyperdynamic: Greater than 70% 1
  • Normal: 50% to 70% 1
  • Mildly diminished/reduced: 40% to 49% 1, 3
  • Moderately diminished/reduced: 30% to 39% 1
  • Severely diminished/reduced: Less than 30% 1

Clinical Significance of LVEF Values

• LVEF is a powerful predictor of cardiovascular outcomes across a broad spectrum of ventricular function. 4
• The risk of cardiovascular death increases by 39% for every 10% reduction in ejection fraction below 45%. 4
• Heart failure is categorized based on LVEF:
  • Heart failure with reduced ejection fraction (HFrEF): LVEF ≤40% 3
  • Heart failure with mildly reduced ejection fraction (HFmrEF): LVEF 41-49% 3
  • Heart failure with preserved ejection fraction (HFpEF): LVEF ≥50% 3

Measurement Considerations

• LVEF is calculated as: (End-diastolic volume - End-systolic volume)/End-diastolic volume × 100 1
• Quantitative measurement of LVEF is preferred over qualitative assessment 1
• LVEF is not significantly related to gender, age, or body size 2
• Serial assessment should be performed using the same vendor's equipment and software due to intervendor variability 2

Clinical Examples

• A normal LVEF of 55% was documented in a case study of a patient with ST-segment elevation myocardial infarction who was successfully treated with balloon angioplasty and stenting 5
• In patients with severe aortic stenosis, preserved ejection fraction is typically defined as ≥50% 5

Important Caveats

• A single LVEF measurement at one time point may not be adequate, particularly for values in the mildly reduced range (41-49%) 1
• LVEF measurement varies between imaging modalities and interpreters 1
• In heart failure patients, once LVEF is elevated to a range above 45%, ejection fraction does not further contribute to assessment of cardiovascular risk 4
• Low normal LVEF (50-55%) in asymptomatic individuals is associated with increased risk for incident congestive heart failure compared to normal LVEF (≥55%) 6