Ejection fraction assessment and left ventricular contractile function: How accurate is this parameter?

Evaluation of the left ventricular (LV) ejection fraction (EF) is a key component for diagnosis and treatment of heart failure (HF). Echocardiography is commonly used to assess LV systolic function and LV EF due to its simplicity and availability. However, it has some limitations, including interand intra-observer variability, dependence on the quality of visualization, etc. HF trials showed that there are some differences in the HF therapy effectiveness depending on the value of LV EF. These results suggest that basic therapy for HF and reduced LVEF is also effective in HF and preserved LVEF if patients have impairment of not only diastolic but also systolic function. Thus, LVEF may not be a reliable parameter to guide treatment decisions andit is necessary to introduce additional markers into clinical practice to assess LV systolic function. The purpose of this review is to discuss the difficulties of assessing LV systolic function using echocardiography and the possibilities of using alternative diagnostic methods, in particular myocardial deformation (speckle tracking echocardiography).