# Left ventriculography Left Ventricular Ejection Fraction Assessment by Visual Estimation

 Coronary Angiography

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

Left ventricular ejection fraction (LVEF) can be visually estimated by comparing the contour of the left ventricle (LV) between the end-systolic frame and the end-diastolic frame on left ventriculography.

## Calculation

By definition, the volume of blood within a ventricle at the end of diastole is the end-diastolic volume (EDV). Likewise, the volume of blood left in a ventricle at the end of systole (contraction) is the end-systolic volume (ESV). The difference between EDV and ESV is the stroke volume (SV). The ejection fraction is the fraction of the end-diastolic volume that is ejected with each beat; that is, it is stroke volume (SV) divided by end-diastolic volume (EDV):

${\displaystyle EF(\%)={\frac {SV}{EDV}}\times 100}$

Where the stroke volume is given by:

${\displaystyle SV=EDV-ESV}$

EF is inherently a relative measurement—as is any fraction, ratio, or percentage, whereas the stroke volume, end-diastolic volume or end-systolic volume are absolute measurements.

## Classification

According to the ACC Heart Failure Clinical Toolkit, based on the quantitative results of LVEF assessment, left ventricular function can be classified into the following qualitative categories:

• Hyperdynamic = LVEF greater than 70%
• Normal = LVEF 50% to 70% (midpoint 60%)
• Mild dysfunction = LVEF 40% to 49% (midpoint 45%)
• Moderate dysfunction = LVEF 30% to 39% (midpoint 35%)
• Severe dysfunction = LVEF less than 30%