7.

Define ejection Fraction and outline its diagnostic and prognostic value in
heart failure
Stroke volume is the volume of blood ejected by the ventricle on each beat;
Ejection fraction is the fraction of the end-diastolic volume ejected in each
stroke volume, which is a measure of ventricular efficiency
Ejection Fraction
The effectiveness of the ventricles in ejecting blood is described by the ejection
fraction, which is the fraction of the end-diastolic volume that is ejected in one
stroke volume. End-diastolic volume is the amount of blood that is in the
ventricles before the heart contracts. Stroke volume is the volume of blood ejected
by the ventricle on each beat. Normally, ejection fraction is approximately 0.55, or
55%. The ejection fraction is an indicator of contractility, with increases in ejection
fraction reflecting an increase in contractility and decreases in ejection fraction
reflecting a decrease in contractility. Thus
Stroke Volume
Ejection fraction= End−diastolic volume

Usually expressed as a percentage, so fraction can be multiplied by 100

Ejection fraction values:
 41-49% = Mildly reduced ejection fraction, considered borderline reduced
 40% = reduced ejection fraction
 50-70% considered normal
 >75% high ejection fraction
Diagnostic value of ejection fraction
 40% to 49%Below normal heart function. Can indicate previous heart
damage from heart attack or cardiomyopathy.
 Higher than 75% – Can indicate a heart condition like hypertrophic
cardiomyopathy, a common cause of sudden cardiac arrest.
 Less than 40% – May confirm the diagnosis of heart failure.
In severe mitral valve regurgitation, the heart has to work harder to pump enough
blood to the body. The extra effort causes the left lower heart chamber (ventricle)
to get bigger. Untreated, the heart muscle becomes weak. This can cause heart
failure.
Mitral valve regurgitation can develop into left ventricular heart failure through a
process of progressive hemodynamic and structural changes in the heart.
When the mitral valve is damaged and does not close properly, blood can flow
back into the left atrium during ventricular systole, which is called mitral
regurgitation. In severe mitral valve regurgitation, the heart has to work harder to
pump enough blood to the body. Over time, these changes can cause left
ventricular hypertrophy, which is an increase in the size and thickness of the heart
muscle. This is the heart's compensatory mechanism to maintain cardiac output and
However, left ventricular hypertrophy can eventually lead to left ventricular
dysfunction and heart failure, as the heart muscle becomes less effective at
pumping blood. Additionally, The thickened heart muscle can become stiff and
less flexible, which can impair the heart's ability to fill properly during diastole,
when the heart is relaxed and blood is flowing into the ventricles. Both these
factors then cause reduced ejection fraction <40%, indicative of heart failure

As the left ventricular dysfunction progresses, blood can back up into the lungs,
causing symptoms of pulmonary congestion, such as shortness of breath and
coughing. This is known as left-sided heart failure, as it primarily affects the left
side of the heart.
Prognostic value of ejection fraction in heart failure
 The prognosis of affected patients is poor: approximately 50% of patients
diagnosed with heart failure die within 5 years
 Study done by Xu et al. “Prognosis of patients with heart failure and reduced
ejection fraction in China” :
“The patients were followed up for a median of 31 months [a bit more than 2
and a half years] Heart failure death occurred in 25% of patients with LVEF
≤35% and 12% of patients with LVEFs of 36–45%. Moreover, sudden death
occurred in 8 and 4% of patients with LVEFs of ≤35 and 36–45%, respectively
(P=0.046)”
Simplified representation of the vicious circle in heart failure ultimately
responsible for the disease’s poor prognosis. The aim of drug therapy as well as
device-based therapy is to stop or interrupt this downward spiral.