Left Ventricular Systolic Function
Assessment
Overview
How is left ventricular (LV) systolic function assessed on echo?
LV systolic function is assessed using several complementary methods:
- Visual estimation ("eyeballing") of ejection fraction — fast, but operator-dependent.
- Simpson's biplane method — the recommended quantitative EF, traced in apical 4- and 2-chamber views.
- MAPSE / TAPSE — longitudinal function surrogates for the LV and RV.
- Global longitudinal strain (GLS) — sensitive, detects early dysfunction before EF falls.
| Category | Ejection fraction |
|---|---|
| Normal | ≥ 55% |
| Mild impairment | 45–54% |
| Moderate impairment | 36–44% |
| Severe impairment | ≤ 35% |
Definition
- Ejection fraction (EF)
- The percentage of end-diastolic volume ejected each beat; the standard index of LV systolic function.
| Normal | >=52 (men) / >=54 (women) | % |
| Mildly reduced | 41-51 | % |
| Moderately reduced | 30-40 | % |
| Severely reduced | <30 | % |
Quantitative LVEF grading follows published chamber-quantification standardsTextbookLang RM, et al. J Am Soc Echocardiogr, 2015..
Equation
Ejection fraction
Fraction of end-diastolic volume ejected.
What is "eyeballing" of LV function, and how reliable is it?
"Eyeballing" is rapid visual estimation of ejection fraction by an experienced operator.
- Fast and practical at the bedside in critical care.
- Correlates well with quantitative EF in experienced hands.
- Highly operator-dependent — reliability falls with inexperience.
- Confirm with a quantitative method (e.g. Simpson's) when a decision hinges on precise EF.