Challenging the Holy Grail of Echo | 123sonography: Left ventricular ejection fraction (LVEF) is the “Holy Grail of cardiology”. When you enter the keyword “ejection fraction” into the search engine of pubmed you will get close to 40,000 hits. If you use the term in Google you get over 1,2 Million. Ejection fraction is everywhere. It is used to define disease, determine its severity, establish the prognosis and most of all to guide therapy. Ejection fraction is part of many guidelines. Based on cut off values for LVEF we recommend valve operation, ICD implantation or even which medication patients should receive. We are literally “forced” to obey to the Holy Grail of ejection fraction in our daily practice. But should we really follow blindly? Sure, it is cool to have a number available that gives you guidance, something to cling to in the world of uncertainty.
But….
There is one problem: The ejection fraction we get does not tell us the entire story. In some situations it is even misleading. And I am not talking about false measurements due to technical limitations or poor image quality. (This itself is another story). Let me give you some examples to show you what I mean:
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