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Left ventricular ejection fraction: are the revised cut-off points for defining systolic dysfunction sufficiently evidence based?

¹ Department of Cardiovascular Medicine, University of Birmingham, UK
² University Department of Medicine, City Hospital, Birmingham, UK
³ Department of Primary Care and General Practice, University of Birmingham, UK
⁴ Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK

Correspondence to:
Dr G Mahadevan, Department of Cardiovascular Medicine, University of Birmingham, 21 Metchley Park Road, Edgbaston, Birmingham B15 2PQ, UK; devanm88@hotmail.com

Accepted
19 June 2007

The first 150 words of the full text of this article appear below.

The recent guidelines from the American Society of Echocardiography and European Society of Echocardiography have defined an abnormal ejection fraction (EF) of the left ventricle, as one that is <55%.¹ Owing to the fact that it is a continuous biological variable, there is inevitable debate over what constitutes mild, moderate and severe left ventricular (LV) dysfunction across the ranges of EF. Up to now, the lower limit of normal in clinical practice has usually been set at 40%.²

Despite the recent guidelines,¹ there has been little debate or evidence to suggest altering the lower limit of normality to include patients with EFs of 50–54%. These guidelines therefore represent a step change in the definition of (echocardiographic) LV systolic dysfunction and will include many more patients into the category of "impaired LV function" with EFs >50%. The main limitation of this approach is how best to define risk. The cut-off points . . . [Full text of this article]

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