Author + information
- Received August 18, 2017
- Revision received September 4, 2017
- Accepted September 10, 2017
- Published online October 30, 2017.
- Michael R. Bristow, MD, PhDa,∗ (, )
- David P. Kao, MDa,
- Khadijah K. Breathett, MDb,
- Natasha L. Altman, MDa,
- John Gorcsan III, MDc,
- Edward A. Gill, MDa,
- Brian D. Lowes, MD, PhDd,
- Edward M. Gilbert, MDe,
- Robert A. Quaife, MDa and
- Douglas L. Mann, MDc
- aDivision of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
- bDivision of Cardiology, Department of Medicine, University of Arizona, Tucson, Arizona
- cDivision of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
- dDivision of Cardiology, Department of Medicine, School of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
- eDivision of Cardiology, Department of Medicine, School of Medicine, University of Utah Medical Center, Salt Lake City, Utah
- ↵∗Address for correspondence:
Dr. Michael R. Bristow, Division of Cardiology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Campus Box B139, Aurora, Colorado 80045.
Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.
- ejection fraction
- gene expression
- heart failure
- left ventricular function
- left ventricular structure
Supported by U.S. National Heart, Lung, and Blood Institute (NHLBI) grant 1R01HL48013 to Drs. Bristow and Lowes; NHLBI grant 2R01 HL48013 to Drs. Bristow, Lowes, Gilbert, Kao, and Quaife; American Heart Association Heart Failure grant SFRN 16SFRN31420008 to Drs. Bristow, Altman, Breathett, Kao, Gill, and Gilbert; NHLBI grant 1K08HL125725 to Dr. Kao; NHLBI grants R01 HL73017 and R01 HL089543 to Dr. Mann. Dr. Bristow is an officer and director of ARCA biopharma; and sponsor of the drug referred to in Online Reference 14. Dr. Quaife has received imaging equipment support from Phillips Corp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 18, 2017.
- Revision received September 4, 2017.
- Accepted September 10, 2017.
- 2017 American College of Cardiology Foundation
- Central Illustration
- Historical Emergence of the Ejection Fraction Concept
- LVEF Measures the 2 Major Characteristics of Pathologic Eccentric Remodeling
- Experience With LVEF as a Remodeling Index
- Advantages of LVEF as an Imaging Measurement
- Methods for Optimizing Measurements of LVEF, and Future Directions for Ventricular Chamber Phenotyping in Heart Failure