Is a left ventricular ejection fraction (LVEF) of 75% considered normal on a stress test?

Is LVEF of 75% Normal on Stress Test?

Yes, an LVEF of 75% on a stress test is considered normal to mildly hyperdynamic and falls within the established normal range, though it warrants clinical correlation to exclude technical factors or underlying conditions that may artificially elevate the measurement. 1

Normal LVEF Reference Ranges

The established normal range for LVEF varies slightly by measurement method but consistently includes 75%:

• Nuclear cardiology (gated SPECT): Normal LVEF is defined as >60%, with example reports showing 70% as normal 2
• 2D echocardiography (biplane Simpson's method): Normal range is 53-73% with mean of 63 ± 5% 1
• General guidelines: The American College of Cardiology defines normal LVEF as 50-70% with a midpoint of 60%, while values >70% are classified as hyperdynamic 1

Your LVEF of 75% falls just above the upper limit of the typical normal range but is not pathologically elevated.

Clinical Interpretation of 75% LVEF

An LVEF of 75% should prompt consideration of several factors:

Physiologic Explanations

• Normal stress response: Healthy individuals demonstrate an increase in LVEF during stress, with increases of 5-7% being typical 3, 4
• Adequate contractile reserve: An LVEF reserve (stress EF minus rest EF) of >5% is normal and helps exclude severe coronary disease 4
• Exercise-induced augmentation: Mental stress and exercise can increase LVEF by approximately 6-7% in healthy volunteers 3

Technical and Clinical Factors to Verify

Volume status and loading conditions can artificially elevate LVEF 1:

• Hypovolemia or dehydration reduces end-systolic volume, mathematically increasing LVEF
• Small ventricular cavity size may produce calculations >70% 1

Reduced afterload conditions that should be considered 1, 5:

• Mitral regurgitation (even mild) reduces afterload and can elevate LVEF
• Other valvular regurgitation
• Vasodilator medications

Measurement quality verification 1:

• Confirm adequate endocardial border visualization
• Verify consistent methodology if comparing to prior studies
• Document that both rest and stress images were technically adequate

When to Investigate Further

While 75% is within normal limits, consider additional evaluation if:

Clinical Red Flags

• Symptoms despite preserved LVEF: Dyspnea, fatigue, or exercise intolerance may indicate diastolic dysfunction, which can coexist with hyperdynamic systolic function 1, 5
• Small ventricular cavity: Document LV dimensions to ensure the ventricle is not abnormally small, which could artificially elevate the calculated EF 1
• Suspected valvular disease: Particularly mitral regurgitation, which creates a low-resistance ejection pathway and can mask underlying myocardial dysfunction 5

Complementary Assessments

• Left atrial size and diastolic parameters: If heart failure symptoms are present, assess for diastolic dysfunction 1
• Global longitudinal strain (GLS): Normal is >-20% (more negative); values >-16% (less negative) indicate subclinical dysfunction even with preserved LVEF 1, 6
• Serial measurements: A single LVEF measurement may not be adequate for borderline values; use the same equipment and methodology for comparison 1

Important Caveats

LVEF is load-dependent and cannot distinguish between preload, afterload, and intrinsic contractility 1:

• Higher LVEF does not always mean better cardiac function
• In conditions like mitral regurgitation, a "normal" LVEF may actually represent early myocardial dysfunction (ideally should be >64% in severe MR) 5

Avoid relying on a single measurement for clinical decision-making, particularly when the value is at the extremes of normal 1

Document clinical context: Record blood pressure, heart rate, rhythm, medications, and volume status at the time of the study, as these dramatically affect interpretation 6

Practical Recommendation

For an asymptomatic patient with LVEF of 75% on stress testing and no concerning features, this represents normal cardiac function with appropriate contractile reserve. 2, 1, 4 However, if symptoms are present or there are other concerning echocardiographic findings (left atrial enlargement, valvular disease, small LV cavity), pursue additional evaluation including assessment of diastolic function, valvular pathology, and consideration of advanced metrics like global longitudinal strain. 1, 5, 6