Clinical Report: Comprehensive Cardiac Function Assessment Beyond Ejection Fraction

Overview

This review discusses the limitations of left ventricular ejection fraction (LVEF) in cardiac functional assessment and proposes a five-dimensional multimodality imaging framework.

Background

Cardiac functional assessment is crucial for diagnosing and managing cardiovascular diseases. Traditionally, LVEF has been the primary measure, but it fails to capture the complexities of cardiac physiology, particularly in conditions like heart failure with preserved ejection fraction (HFpEF). A multidimensional approach is necessary due to the limitations of LVEF.

Data Highlights

No numerical data or trial data provided in the article.

Key Findings

• LVEF is limited in sensitivity to early myocardial dysfunction and does not account for right ventricular and left atrial contributions.
• The proposed five-dimensional framework includes pump function, myocardial deformation, diastolic function, flow dynamics, and tissue characterization.
• Multimodality imaging should follow a selective stepwise escalation strategy, starting with standard echocardiography.
• Integration of biomarkers across functional domains may enhance the interpretation of cardiac dysfunction.
• Practical barriers to implementation include cost-effectiveness and the need for standardized protocols.

Clinical Implications

The proposed framework may guide the selection of imaging modalities based on clinical context and specific patient needs.

Conclusion

The shift from LVEF to a comprehensive imaging framework may lead to better patient outcomes.

Related Resources & Content

1. Houston Methodist Hospital, Heart Failure I: Evaluating Myocardial Viability-Role of Multimodality Imaging, 2026 -- Heart Failure I: Evaluating Myocardial Viability-Role of Multimodality Imaging
2. Clinical Research in Cardiology, Evaluating the Prognostic Utility of a Combined Clinical and Echocardiographic Risk Score for Predicting Cardiovascular Outcomes in Patients with Ischemic Heart Failure and Reduced Ejection Fraction, 2024 -- Evaluating the Prognostic Utility of a Combined Clinical and Echocardiographic Risk Score for Predicting Cardiovascular Outcomes in Patients with Ischemic Heart Failure and Reduced Ejection Fraction
3. JMIR Medical Informatics, Multimodal Fusion of Echocardiogram Images and Electronic Medical Records for Heart Disease Screening: Retrospective Algorithm Development and Validation Study, 2026 -- Multimodal Fusion of Echocardiogram Images and Electronic Medical Records for Heart Disease Screening: Retrospective Algorithm Development and Validation Study
4. Clinical Research in Cardiology, Evaluating Diastolic Function with Cardiac Magnetic Resonance Imaging as a Substitute for Echocardiography: Normal Reference Values Based on Age and Gender, 2024 -- Evaluating Diastolic Function with Cardiac Magnetic Resonance Imaging as a Substitute for Echocardiography: Normal Reference Values Based on Age and Gender
5. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography, 2025 -- Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis
6. Society for Cardiovascular Magnetic Resonance, Expert Consensus Statement on Quantitative Myocardial Perfusion Cardiovascular Magnetic Resonance Imaging, 2025 -- Expert Consensus Statement on Quantitative Myocardial Perfusion Cardiovascular Magnetic Resonance Imaging
7. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography
8. Society for cardiovascular magnetic resonance expert consensus statement on quantitative myocardial perfusion cardiovascular magnetic resonance imaging - PMC
9. Effect of SGLT2 inhibitors on cardiac structure and function assessed by cardiac magnetic resonance: a systematic review and meta-analysis - PMC