title: Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure.
abstract: Left ventricular ejection fraction (LVEF) has been the central parameter used for diagnosis and management in patients with heart failure. A good predictor of adverse outcomes in heart failure when below ∼45%, LVEF is less useful as a marker of risk as it approaches normal. As a measure of cardiac function, ejection fraction has several important limitations. Calculated as the stroke volume divided by end-diastolic volume, the estimation of ejection fraction is generally based on geometric assumptions that allow for assessment of volumes based on linear or two-dimensional measurements. Left ventricular ejection fraction is both preload- and afterload-dependent, can change substantially based on loading conditions, is only moderately reproducible, and represents only a single measure of risk in patients with heart failure. Moreover, the relationship between ejection fraction and risk in patients with heart failure is modified by factors such as hypertension, diabetes, and renal function. A more complete evaluation and understanding of left ventricular function in patients with heart failure requires a more comprehensive assessment: we conceptualize an integrative approach that incorporates measures of left and right ventricular function, left ventricular geometry, left atrial size, and valvular function, as well as non-imaging factors (such as clinical parameters and biomarkers), providing a comprehensive and accurate prediction of risk in heart failure.
authors.affiliation: Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Maja
authors.initials: M
authors.lastname: Cikes
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA ssolomon@rics.bwh.harvard.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D057791:Cardiac Imaging Techniques / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000473:pathology; D004452:Echocardiography / Q000379:methods; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D017725:Ventricular Pressure / Q000502:physiology
keywords: Deformation imaging; Echocardiography; Ejection fraction; Heart failure; Outcomes; Risk assessment