Your Heart Surgeon Is Incorrect: An EF of 55-60% Is Normal for Your Age
Your ejection fraction of 55-60% is completely normal for an elderly patient and does not indicate a weak heart. The surgeon's claim that 65-70% should be the standard is not supported by evidence-based guidelines and represents a fundamental misunderstanding of normal cardiac physiology across the lifespan.
What the Evidence Actually Shows About Normal EF
Age-Related Changes in Normal EF
The lower limit of normal EF varies significantly by age and sex. A comprehensive meta-analysis of over 22,000 subjects found that for a 30-year-old European man, the lower limit of normal (5th percentile) EF is 49%, whereas for an East Asian woman aged >50 years, it is 57% 1.
Normal EF is generally defined as ≥50% in current guidelines, not 65-70% 1, 2. The American College of Cardiology specifically defines heart failure with preserved ejection fraction (HFpEF) as requiring an EF ≥50%, meaning anything at or above 50% is considered "preserved" or normal systolic function 2.
Your EF of 55-60% falls well within the normal range and would be classified as preserved ejection fraction, not reduced 1, 2.
The Danger of Setting the Bar Too High
Setting an artificially high threshold like 65-70% would incorrectly label most normal elderly patients as having cardiac dysfunction. This is not supported by any major cardiology society guidelines 1.
Even "low normal" EF (50-55%) in asymptomatic adults carries only a modestly increased risk of future heart failure compared to EF ≥55%, with a hazard ratio of 3.64 for incident heart failure over 10 years, but importantly, no increased mortality risk in fully adjusted models 3.
The Clinical Reality: What Actually Matters
EF Alone Doesn't Define Heart Strength
Heart failure is a clinical syndrome, not just an ejection fraction number. The American College of Cardiology emphasizes that diagnosis requires three components: symptoms and/or signs, structural/functional cardiac abnormality, and either elevated natriuretic peptides or objective evidence of congestion 2.
Many elderly patients with heart failure actually have preserved EF. In one large study of 2,671 patients followed longitudinally, as many as 57% had a normal or borderline low LVEF at the time of their first hospitalization for heart failure 1.
In elderly hospitalized heart failure patients, 61% had EF ≥50%, demonstrating that preserved EF is the predominant pattern in older adults with symptomatic heart failure 4.
Outcomes Are What Matter, Not Arbitrary Numbers
Patients with heart failure and normal EF (≥55%) actually have better survival than those with reduced EF, though still worse than age-matched controls without heart failure 5, 6.
In the Framingham Heart Study, CHF patients with normal LVEF (≥50%) had an annual mortality of 8.7% versus 18.9% for those with reduced LVEF, confirming that preserved EF carries a better prognosis 6.
The relationship between EF and outcomes shows a U-shaped curve in some populations. Interestingly, one study of elderly women with acute coronary syndromes found that those with very high EF (>65%) actually had worse outcomes than those with normal EF (55-65%), with a 2.5-fold increased risk of hospital death 7. This directly contradicts the notion that "higher is always better."
The Bottom Line for Your Situation
Your EF Is Normal
An EF of 55-60% in an elderly patient represents normal left ventricular systolic function by all established guideline criteria 1, 2.
You do not have a "weak heart" based on this EF measurement alone. Whether you have heart disease depends on symptoms, other structural abnormalities, and functional capacity—not just the EF number 2.
What Actually Indicates Cardiac Dysfunction
If you were to have heart problems, the evidence would include:
- Symptoms such as dyspnea, fatigue, orthopnea, or edema 2
- Elevated natriuretic peptides (BNP >35 pg/mL) 2
- Diastolic dysfunction markers on echocardiography such as E/E' ratio >15, left atrial enlargement, or abnormal filling patterns 1, 2
- Reduced exercise capacity measured by peak VO2 or 6-minute walk distance 1
- Other structural abnormalities such as significant valve disease, left ventricular hypertrophy, or regional wall motion abnormalities 1
Important Caveats
Genetic factors account for only 1-3% of variance in EF measurements in predominantly Caucasian populations, while age, body mass, hypertension, and metabolic factors play much larger roles 1.
The more precise the measurement, the more difficult it becomes to discriminate health from disease, creating what has been called a "paradox of precision" 1.
Different reference ranges should be used for male and female subjects of all ages and for different ethnic groups 1.
Your surgeon's standard of 65-70% is not evidence-based and would inappropriately pathologize normal cardiac function in elderly patients. Your EF of 55-60% is reassuring, not concerning.