View source for Left ventriculography Left Ventricular Ejection Fraction Assessment by Visual Estimation

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==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 (heart)|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):<ref>{{cite book|url=https://books.google.com/books?id=x8EDupFXjloC&q=table+6.2&pg=PT382|title=Feigenbaum's Echocardiography|last1=Armstrong|first1=William F.|last2=Ryan|first2=Thomas | name-list-style = vanc |date=2012-02-03|publisher=Lippincott Williams & Wilkins|isbn=9781451147834|pages=126 }}</ref>

<math>EF (\%) = \frac{SV}{EDV}\times100</math>

Where the stroke volume is given by:

<math>SV = EDV - ESV</math>

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%

==Examples==

===Hyperdynamic (>70%)===

====Case 1: LVEF=75%====

{|
|-
| [[File: 008-0581-1.gif |thumb|400px|]]
| [[File: 008-0581-1-annotated.gif |thumb|400px|]]
|-
|}

====Case 2: LVEF=80%====

<gallery widths=400px>

xxx.png | End-diastolic frame
xxx.png | End-systolic frame
xxx.gif | Left ventriculography

</gallery>

===Normal LVEF (50–70%)===

====Case 1: LVEF=80%====

<gallery widths=400px>

xxx.png | End-diastolic frame
xxx.png | End-systolic frame
xxx.gif | Left ventriculography

</gallery>

====Case 2: LVEF=80%====

<gallery widths=400px>

xxx.png | End-diastolic frame
xxx.png | End-systolic frame
xxx.gif | Left ventriculography

</gallery>

===Mild dysfunction (40–49%)===

====Case 1: LVEF=80%====

<gallery widths=400px>

xxx.png | End-diastolic frame
xxx.png | End-systolic frame
xxx.gif | Left ventriculography

</gallery>

====Case 2: LVEF=80%====

<gallery widths=400px>

xxx.png | End-diastolic frame
xxx.png | End-systolic frame
xxx.gif | Left ventriculography

</gallery>

===Moderate dysfunction (30–39%)===

====Case 1: LVEF=80%====

<gallery widths=400px>

xxx.png | End-diastolic frame
xxx.png | End-systolic frame
xxx.gif | Left ventriculography

</gallery>

====Case 2: LVEF=80%====

<gallery widths=400px>

xxx.png | End-diastolic frame
xxx.png | End-systolic frame
xxx.gif | Left ventriculography

</gallery>