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Left ventricular ejection fraction: clinical, pathophysiological, and technical limitations
Department of Internal Medicine, S.Elia Hospital, Caltanissetta, Italy.
Cardiovascular and Interventional Department, S.Elia Hospital, Caltanissetta, Italy.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-6089-5614
2024 (English)In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 11, article id 1340708Article, review/survey (Refereed) Published
Abstract [en]

Risk stratification of cardiovascular death and treatment strategies in patients with heart failure (HF), the optimal timing for valve replacement, and the selection of patients for implantable cardioverter defibrillators are based on an echocardiographic calculation of left ventricular ejection fraction (LVEF) in most guidelines. As a marker of systolic function, LVEF has important limitations being affected by loading conditions and cavity geometry, as well as image quality, thus impacting inter- and intra-observer measurement variability. LVEF is a product of shortening of the three components of myocardial fibres: longitudinal, circumferential, and oblique. It is therefore a marker of global ejection performance based on cavity volume changes, rather than directly reflecting myocardial contractile function, hence may be normal even when myofibril's systolic function is impaired. Sub-endocardial longitudinal fibers are the most sensitive layers to ischemia, so when dysfunctional, the circumferential fibers may compensate for it and maintain the overall LVEF. Likewise, in patients with HF, LVEF is used to stratify subgroups, an approach that has prognostic implications but without a direct relationship. HF is a dynamic disease that may worsen or improve over time according to the underlying pathology. Such dynamicity impacts LVEF and its use to guide treatment. The same applies to changes in LVEF following interventional procedures. In this review, we analyze the clinical, pathophysiological, and technical limitations of LVEF across a wide range of cardiovascular pathologies.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024. Vol. 11, article id 1340708
Keywords [en]
aortic regurgitation, aortic stenosis, echocardiography, implantable cardioverter defibrillator, left ventricular ejection fraction, mitral regurgitation
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-221673DOI: 10.3389/fcvm.2024.1340708PubMedID: 38385136Scopus ID: 2-s2.0-85185511174OAI: oai:DiVA.org:umu-221673DiVA, id: diva2:1841704
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2024-02-29Bibliographically approved

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Henein, Michael Y.

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