Are Clinical Heart Failure and Ejection Fraction Always Connected?

ABSTRACT

Left Ventricular Ejection Fraction % (LVEF%) is an hemodynamic index indicative for left ventricular function. Its numeric value can be obtained by different methods, such as two- or three-dimensional echocardiography, cardiac catheterization, and Nuclear Medicine-methods. It depends not only on myocardial contractility but also on preload and afterload, as well as heart rate and left ventricular distensibility.

Normal LVEF% is recorded in patients with diastolic heart failure. On the contrary, in patients with systolic heart failure, values of LVEF% <40% usually are found. That generally is connected with clinical symptoms of congestive failure. Nevetheless, a mismatch between low LVEF% and congestive signs can be evident in some forms of systolic HF. That may happen in patients with slowly progressive reduction of systolic left ventricular function. In this occurrence, determining factors of LVEF% can mutually balance each other, through in presence of reduction of one or more determinants. In addition, in some valvular cardiac incompetences, as aortic and mitral insufficiency or in congenital heart disease, such as intra-ventricular and intra-atrial defects, LVEF% can be preserved, also in presence of signs of inadequate peripheral perfusion. Conclusively, LVEF% is an useful hemodynamic parameter, that is not always indicative of left ventricular function concerning the peripheral perfusion.

Keywords:

Ejection fraction, systolic and diastolic heart failure, symptoms of congestive HF, aortic and mitral incompetences.