Ejection Fraction Measurement on Echocardiography
Understand Ejection Fraction Measurement on Echocardiography in Heart Echocardiography imaging, what it means, and next steps.
30-Second Overview
Left ventricular ejection fraction (LVEF) calculated from end-diastolic and end-systolic volumes. Normal LVEF is 55-70%. Reduced EF indicates systolic dysfunction.
Ejection fraction is the most important measure of heart's pumping function. Reduced EF (< 50%) indicates heart muscle weakness. EF guides treatment and predicts prognosis.
benignRate
followUp
Imaging Appearance
Echocardiography FindingLeft ventricular ejection fraction (LVEF) calculated from end-diastolic and end-systolic volumes. Normal LVEF is 55-70%. Reduced EF indicates systolic dysfunction.
Clinical Significance
Ejection fraction is the most important measure of heart's pumping function. Reduced EF (< 50%) indicates heart muscle weakness. EF guides treatment and predicts prognosis.
Understanding Ejection Fraction on Echocardiography
Ejection fraction (EF) is one of the most important measurements in cardiology, representing the percentage of blood pumped out of the heart's left ventricle with each beat. This simple number provides crucial information about heart function and guides treatment decisions for countless patients.
Echocardiography is the most common method for measuring ejection fraction, offering a non-invasive, widely available, and accurate assessment of cardiac pumping function.
What Is Ejection Fraction?
Ejection fraction measures how much blood the left ventricle (the heart's main pumping chamber) pumps out with each contraction.
The Physiology of Ejection Fraction
Normal cardiac cycle:
- Diastole: Ventricles fill with blood (end-diastolic volume, EDV)
- Systole: Ventricles contract and eject blood (stroke volume)
- Remaining blood: Some blood remains (end-systolic volume, ESV)
EF calculation:
- EF = (EDV - ESV) / EDV x 100%
- Or: EF = Stroke Volume / End-Diastolic Volume x 100%
Ejection Fraction Categories
Normal EF (55-70%):
- Heart pumping function is normal
- No evidence of systolic dysfunction
- Excellent prognosis
Mildly reduced EF (40-54%):
- Mild systolic dysfunction
- May have minimal symptoms
- Treatment often initiated
Moderately reduced EF (30-39%):
- Moderate systolic dysfunction
- Heart failure symptoms common
- Guideline-directed medical therapy essential
Severely reduced EF (＜ 30%):
- Severe systolic dysfunction
- Significant heart failure
- Consider advanced therapies (ICD, CRT)
- Higher mortality risk
Epidemiology and Risk Factors
Each 5% reduction in EF below 55% is associated with increased mortality and heart failure hospitalization. EF is a powerful prognostic indicator.
Heart failure with reduced EF (HFrEF) affects millions:
Major risk factors:
- Coronary artery disease: Previous MI, chronic ischemia
- Hypertension: Long-standing uncontrolled high blood pressure
- Valvular disease: Especially aortic regurgitation or mitral regurgitation
- Cardiomyopathy: Dilated, hypertrophic, or restrictive types
- Toxins: Alcohol, cocaine, chemotherapy (especially doxorubicin)
Echocardiographic Measurement
Methods for Measuring EF
Experienced operators using 3D methods achieve accuracy comparable to cardiac MRI
Correctly rules out healthy patients
Annual new cases
1. Simpson's Biplane Method (most accurate 2D method):
- Traces ventricular border in apical 4-chamber and 2-chamber views
- Computer calculates volumes using disc summation
- Considered the standard 2D method
2. 3D Echocardiography (most accurate):
- Volumetric measurement without geometric assumptions
- Most accurate echo method
- Correlates best with cardiac MRI
3. Visual estimation (experienced operators):
- Qualitative assessment by experienced echocardiographer
- Correlates reasonably well with quantitative methods
Comparing Normal and Reduced EF
Normal Ejection Fraction (55-70%)
Vigile contraction of all walls. Normal wall thickness (6-11 mm). End-diastolic volume normal. End-systolic volume small. Normal stroke volume (60-100 mL). Symmetric contraction.
Reduced Ejection Fraction (＜ 50%)
Reduced contraction amplitude (hypokinesis). Thinned walls in chronic cases. Dilated ventricle (increased EDV). Large end-systolic volume. Reduced stroke volume. May have regional wall motion abnormalities or global hypokinesis.
Clinical Presentation
Typical Patient Scenario
Clinical Scenario
Differential Diagnosis of Reduced EF
What Else Could It Be?
Regional wall motion abnormalities corresponding to coronary distribution. History of MI or angina. May have viable myocardium in some territories. Stress test or angiography diagnostic.
Global hypokinesis without regional variation. Dilated LV with reduced wall thickness. No evidence of ischemia. Exclusion of other causes required. Family history possible.
Concentric LV hypertrophy initially. May progress to dilation and reduced EF. LA enlargement common. History of hypertension. Aortic sclerosis may be present.
Primary valve abnormality (aortic stenosis, mitral regurgitation) leading to volume or pressure overload. EF reduced as compensatory mechanism fails. Valve morphology abnormal.
Management Based on EF
Guideline-Directed Medical Therapy
What Happens Next?
Initiate guideline-directed medical therapy
Beta-blocker (carvedilol, metoprolol succinate, bisoprolol). ACE inhibitor/ARB/ARNI. Aldosterone antagonist if indicated. SGLT2 inhibitor (dapagliflozin, empagliflozin). Combination therapy improves survival.
Assess for ischemia
Stress testing or coronary angiography if not recently done. Revascularization if viable myocardium and ischemia present. Ischemic evaluation crucial if EF reduced.
Device therapy consideration
ICD consideration if EF ≤ 35% after 3 months optimal therapy. Cardiac resynchronization (CRT) if EF ≤ 35%, LBBB, QRS ≥ 150 ms. Shared decision-making essential.
Monitor response to therapy
Repeat echocardiogram to assess EF recovery. Titrate medications to target doses. Assess symptom improvement. Consider advanced therapies if no improvement.
Frequently Asked Questions
What is a normal ejection fraction?
Normal ejection fraction is 55-70%. This means the left ventricle pumps out more than half of its blood content with each beat. Some people naturally have EF in the 50-54% range, which is borderline but often acceptable.
Can ejection fraction improve?
Yes, ejection fraction can improve with appropriate treatment. Up to 20% of patients with initially reduced EF show complete normalization, and another 30-40% have significant improvement. Recovery is more likely with recent onset, treatable causes, and aggressive guideline-directed medical therapy.
References
- American Society of Echocardiography. Guidelines for Cardiac Chamber Quantification by Echocardiography. 2023.
- European Association of Cardiovascular Imaging. Recommendations for Cardiac Chamber Quantification. 2022.
- Lang RM, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults. J Am Soc Echocardiogr. 2023.
Medical Disclaimer: This information is educational only. Always discuss findings with your healthcare provider for personalized medical advice.
🔗Explore Related Content
Deepen your understanding with related imaging terms, lab tests, and diseases
Recommended Learning Path
Build comprehensive understanding through structured learning
Have a Echocardiography Report?
Upload your PDF report for quick plain-language explanations of terms like "Ejection Fraction Measurement on Echocardiography". WellAlly helps you understand your radiology results.