Sophia Antipolis, France (April 22, 2025) – The Heart Failure Society of America (HFSA), the Heart Failure Association of the European Society of Cardiology (HFA of the ESC), and the Japanese Heart Failure Society (JHFS) announced today a new joint scientific statement titled The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure.
Left ventricular ejection fraction (LVEF) has long served as a central measure in assessing cardiac function and guiding heart failure (HF) management. However, limitations in its diagnostic precision, reproducibility, and relevance across the full spectrum of HF phenotypes have prompted experts to re-evaluate its role. This new statement, developed by an international panel of 21 HF experts through the Trilateral International Consensus Conference (TICC), offers a comprehensive reassessment of the use of LVEF and introduces a dynamic, trajectory-based framework for classifying and managing HF.
The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure statement offers expert consensus and guidance for clinicians on key areas of HF diagnosis and treatment, with a particular focus on:
- Historical context and evolution of LVEF as a measure
- Limitations of current LVEF-based classification systems
- The role of LVEF trajectories in diagnosis, prognosis, and therapy selection
- Emerging imaging techniques and biomarkers for myocardial characterisation
- Therapeutic implications across the full spectrum of LVEF, including supra-normal EF
- Future directions in HF stratification and management
Despite widespread reliance on single-point LVEF measurements to define heart failure phenotypes such as HFrEF, HFmrEF, and HFpEF, evidence increasingly shows that these static categories may oversimplify the complex and evolving nature of HF. This joint statement emphasises a shift toward classification based on LVEF trajectories—such as persistently reduced, worsening, or improved LVEF—which provide more accurate prognostic insights and treatment implications.
"The static categorisation of heart failure based on a single LVEF cut-off doesn't capture the dynamic progression or response to therapy in many patients," said John Teerlink, MD, FHFSA, co-author and TICC co-chair representing HFSA. "By focusing on LVEF trajectories, clinicians can make more informed treatment decisions and provide more personalised care. Additionally, there are beneficial therapies that can be initiated in patients with heart failure without knowledge of the LVEF."
The statement also highlights the importance of therapies effective across the full range of LVEF, particularly SGLT2 inhibitors, which demonstrate robust outcomes regardless of EF values, and calls for continued research into novel imaging modalities and myocardial biomarkers that may further refine patient stratification and targeted treatment.
This joint scientific statement was created through the TICC, hosted by the HFA of the ESC in collaboration with the HFSA and JHFS. Giuseppe Rosano (HFA of the ESC), John R. Teerlink (HFSA), and Koichiro Kinugawa (JHFS) served as co-chairs. The TICC brings together leaders from global heart failure societies to develop key scientific statements in the field.
The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure will be jointly published on April 22, 2025, at 9:00 AM EDT in the Journal of Cardiac Failure, the official journal of the HFSA and JHFS, and the European Journal of Heart Failure , the official journal of the HFA of the ESC.
