Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2022; 14(7): 438-445
Published online Jul 26, 2022. doi: 10.4330/wjc.v14.i7.438
Heart failure with reduced, mildly reduced, or preserved left ventricular ejection fraction: Has reasoning been lost?
Andrew Xanthopoulos, Grigorios Giamouzis, John Skoularigis, Filippos Triposkiadis
Andrew Xanthopoulos, Grigorios Giamouzis, John Skoularigis, Filippos Triposkiadis, Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
Author contributions: Xanthopoulos A and Triposkiadis F conceived the study; Xanthopoulos A, Giamouzis G, Skoularigis J, and Triposkiadis F wrote the manuscript; Skoularigis J and Giamouzis G revised the manuscript critically for important intellectual content; All authors provided comments on the manuscript and gave final approval of the version to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrew Xanthopoulos, FACC, MD, PhD, Doctor, Department of Cardiology, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. andrewvxanth@gmail.com
Received: March 11, 2022
Peer-review started: March 11, 2022
First decision: May 31, 2022
Revised: June 9, 2022
Accepted: July 8, 2022
Article in press: July 8, 2022
Published online: July 26, 2022
Processing time: 130 Days and 19.5 Hours
Abstract

Left ventricular (LV) ejection fraction (LVEF), defined as LV stroke volume divided by end-diastolic volume, has been systematically used for the diagnosis, classification, and management of heart failure (HF) over the last three decades. HF is classified as HF with reduced LVEF, HF with midrange or mildly reduced LVEF, and HF with preserved LVEF using arbitrary, continuously changing LVEF cutoffs. A prerequisite for using this LVEF-based terminology is knowledge of the LVEF normal range, which is lacking and may lead to erroneous conclusions in HF, especially at the higher end of the LVEF spectrum.

Keywords: Arbitrary; Cut off; Guidelines; Limitations; Normal left ventricular ejection fraction range; Phenotypic persistence

Core Tip: Left ventricular ejection fraction (LVEF) has been consistently used for the diagnosis, classification, and management of heart failure (HF) over the last three decades. HF is classified as HF with reduced LVEF, HF with midrange or mildly reduced LVEF, and HF with preserved LVEF using arbitrary, continuously changing LVEF cutoffs. A prerequisite for using this terminology is knowledge of the LVEF normal range, which is lacking and may lead to erroneous conclusions, especially at the higher end of the LVEF spectrum.