Patients with Systolic Heart Failure also known as “Heart Failure with Reduced Heart Function (HFrHF)” will commonly present with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea (PND), exercise intolerance, irregular heartbeats, and edema in the bilateral upper and lower extremities. This is usually accompanied by cardiogenic pulmonary edema and B-lines on ultrasound.
One of the most commonly used surrogates in assessing systolic function in these patients is done by measuring the Left Ventricular Ejection Fraction.
Ejection fraction (EF) in percentage is defined as: EF(%) = SV/EDV x 100
Where SV: Stroke Volume and EDV: End Diastolic Volume
Ejection fraction (EF) is basically a percentage, of how much blood the left ventricle pumps out with each contraction. For example, an ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out during each systolic contraction
| Hyperdynamic | Normal | Mildly Reduced | Moderately Reduced | Severely Reduced | |
| Ejection Fraction | >70% | 55-69% | 45-54% | 30-44% | <30% |
Measuring Ejection Fraction on ultrasound can be approached either qualitatively or quantitatively. In this post, we will go over the qualitative technique to assess ejection fraction.
Qualitative Approach to Assessing Ejection Fraction:
- Look at how well the left ventricle walls are moving. Are they coming close to each other during systole?
- Look at how well the anterior mitral valve leaflet is moving. Is it coming close to the ventricular septum during diastole?
If the left ventricular walls are moving well and coming close together during systole and the anterior mitral valve leaflet is almost touching the septum during diastole then the patient likely has a normal ejection fraction.
Conversely if the left ventricular walls are barely moving during systole and the anterior mitral valve leaflet is barely moving during diastole the patient likely has a low ejection fraction.
Here are cardiac ultrasound (echo) images of patients with different degrees of ejection fraction from hyperdynamic to severely reduced:
