The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure. A Clinical Consensus Statement of the Heart Failure Association (HFA) of the ESC, the Heart Failure Society of America (HFSA), and the Japanese Heart Fail
This clinical consensus statement revisits the role of left ventricular ejection fraction (LVEF) as a measurement of cardiac function, a prognostic marker and a major criterion to classify patients with heart failure, and gives new advice for clinical practice. Heart failure is traditionally classified on the basis of LVEF thresholds and this has major implications for treatment recommendations. However, the reproducibility of LVEF measurement is poor and its prognostic and diagnostic value lessens when it is above 45%, with no relationship with the severity of either cardiac dysfunction or outcomes at higher values. These limitations dictate the need for a more comprehensive approach to classify and assess heart failure focusing more on the trajectory of LVEF rather than to its absolute value. Furthermore, the assessment of LVEF is not required for the initiation of treatments like sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists and diuretics in patients with suspected de novo heart failure and elevated N-terminal pro-B-type natriuretic peptide levels. Future research utilizing advanced imaging techniques and biomarkers which can better characterize myocardial structure, metabolism and performance may facilitate the identification of alternative therapeutic targets and better ways to monitor heart failure therapies across the entire spectrum of LVEF.
Authors
- Teruhiko Imamura (ORCID: https://orcid.org/0000-0002-7294-7637)
- Gianluigi Savarese (ORCID: https://orcid.org/0000-0001-7732-0887)
- Antoni Bayés‐Genís (ORCID: https://orcid.org/0000-0002-3044-197X)
- John R. Teerlink (ORCID: https://orcid.org/0000-0001-9527-0852)
- Jane E. Wilcox (ORCID: https://orcid.org/0000-0002-9272-7623)
- Koichiro Kuwahara (ORCID: https://orcid.org/0000-0003-2670-7170)
- James C. Fang (ORCID: https://orcid.org/0000-0003-2427-9504)
- Kazuhiro Yamamoto (ORCID: https://orcid.org/0000-0002-7513-6725)
- Koichiro Kinugawa (ORCID: https://orcid.org/0000-0003-0009-8477)
- Yasuhiko Sakata (ORCID: https://orcid.org/0000-0001-6809-8487)
- Andrew J.S. Coats (ORCID: https://orcid.org/0000-0002-2771-4260)
- Ovidiu Chioncel (ORCID: https://orcid.org/0000-0002-3197-3628)
- Barry Greenberg (ORCID: https://orcid.org/0000-0002-6605-9385)
- Nasrien E. Ibrahim (ORCID: https://orcid.org/0000-0003-3376-5336)
- Anekwe Onwuanyi (ORCID: https://orcid.org/0000-0001-8529-5351)
- Brenda Moura (ORCID: https://orcid.org/0000-0001-6158-7368)
- Nancy K. Sweitzer (ORCID: https://orcid.org/0000-0002-8117-6678)
- Naoki Sato (ORCID: https://orcid.org/0000-0002-5550-0083)
- Takayuki Inomata (ORCID: https://orcid.org/0000-0002-2199-6850)
- Giuseppe M.C. Rosano
- Marco Metra
Institutions
- Northwestern University (US)
- Brigham and Women's Hospital (US)
- Grady Memorial Hospital (US)
- Karolinska University Hospital (SE)
- University of San Diego (US)
- University of California, San Francisco (US)
- Università degli studi di Cassino e del Lazio Meridionale (IT)
- Washington University in St. Louis (US)
- Military Hospital (PK)
- University of Utah Hospital (US)
- San Raffaele University of Rome (IT)
- Brescia University (US)
- University of California San Diego (US)
- University of Warwick (GB)
- Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu" (RO)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (ES)
- National Cerebral and Cardiovascular Center (JP)
- CUF Porto Hospital (PT)
- Tottori University Hospital (JP)
- Shinshu University Hospital (JP)
- Hospital Universitari Germans Trias i Pujol (ES)
- Kitasato Institute Hospital (JP)
- University of Toyama (JP)
- Tottori University (JP)
- Kitasato University (JP)
- University of Brescia (IT)
- Nippon Medical School (JP)
Publication Details
- Journal
- European Journal of Heart Failure
- Published
- 2025-04-22
- DOI
- https://doi.org/10.1002/ejhf.3646
- Citations
- 17
- Primary Topic
- Heart Failure Treatment and Management
- Type
- article
- Field-Weighted Citation Impact
- 23.60