What is the clinical significance of an ejection fraction (EF) of 55% in a 27-year-old male, as measured by the modified Simpson's biplane method?

An Ejection Fraction of 55% in a 27-Year-Old Male is Normal and Requires No Intervention

An ejection fraction of 55% measured by modified Simpson's biplane method in a 27-year-old male falls within the normal range (50-70%) and indicates normal left ventricular systolic function. 1, 2

Normal Reference Values

• The American College of Cardiology/American Heart Association guidelines define normal LVEF as 50-70%, with a midpoint of 60%. 1, 2
• The lower limit of normal is 50%, meaning this patient's EF of 55% is clearly within normal parameters. 2
• Values below 50% would indicate some degree of left ventricular systolic dysfunction. 2

Clinical Significance in a Young Adult

• In an asymptomatic 27-year-old male without known cardiovascular disease, an EF of 55% indicates:
  • Normal cardiac contractility 1
  • Adequate ventricular function for all activities including competitive athletics 3
  • No increased risk for heart failure or adverse cardiovascular outcomes 4

Measurement Reliability

• The modified Simpson's biplane method is the recommended standard for measuring ejection fraction by echocardiography, particularly reliable in both normally and abnormally shaped ventricles. 1
• This method traces endocardial borders in both apical four-chamber and two-chamber views at end-diastole and end-systole, calculating volumes using the biplane method of discs. 1
• The technique avoids geometric assumptions that can fail in abnormal ventricles. 1

Important Caveats

• LVEF measurement has inherent variability of 5-7% between studies due to technical factors rather than actual changes in cardiac function. 2
• Different imaging modalities (echocardiography, MRI, nuclear imaging) yield different absolute values, though all would classify 55% as normal. 5
• In this young, presumably healthy individual, a single normal measurement is adequate and no further cardiac evaluation is indicated based solely on this finding. 2

Contrast with Pathological States

• This normal EF stands in stark contrast to patients with heart failure, where:
  • HFrEF is defined as LVEF ≤40% 1
  • Mildly reduced EF is 40-49% 1, 2
  • Even "low normal" EF (50-54%) in older adults with risk factors carries increased risk for future heart failure 4

Clinical Management

• No specific cardiac intervention, medication, or activity restriction is warranted based on this normal ejection fraction. 3
• Athletes with normal ventricular function (EF ≥50%) can participate in all competitive sports without restriction. 3
• Routine age-appropriate cardiovascular risk factor screening and health maintenance are sufficient. 1