High efficiency The drugs that serve as the basis for the treatment of patients with CHF are confirmed by the results of large randomized trials (Table 1). The role of surgical methods in the treatment of such patients is constantly growing (Fig. 1). Great value has an organization of outpatient monitoring. Although lifestyle measures are considered important, their impact on prognosis has not been proven.

Rice. 1. Algorithm for the treatment of patients with symptomatic HF and reduced EF. RCT - resynchronization therapy. LVEF - left ventricular ejection fraction.

Source: Dickstein K., Cohen-Solal A., Filippatos G. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) // Eur. Heart J. - 2008. - Vol. 29. - P. 2388-2422.

Table 1

Results of randomized controlled trials* of patients with symptomatic chronic heart failure and low left ventricular ejection fraction

Le- reading, researched dova- nie, year published cation	N	Death- ness V first year y pain- nykh, accepted waving pla- cebo/ con- role-playing group py	Previous I am more treat- tion **	To- bav- le- nia To tera- FDI	OSR, % ***	Pre- until then puppy events tiy on 1000 pain- nykh, semi- cherished treat- tion ††
						Sme mouth	State option By CH	Sme mouth or Mr. tion By WITH N
CON- SEN- SUS, 1987	253	52	Spiro	Ena- lapril 20 mg 2 times per day	40	146	-	-
SOLVD- T, 1991	25 69	15,7	-	Ena- lapril 20 mg 2 times per day	16	45	96	108
CIBIS- 2, 1999	26 47	13,2	ACEI	Biso- screwed up 10 mg 1 time per day	34	55	56	-
MERIT- HF, 1999	39 91	11,0	ACEI	Metho- screwed up 200 mg 1 time per day	34	36	46	63
COPER- NICUS, 2001	22 89	19,7	ACEI	Karve- dilol 25 mg 2 times per day	35	55	65	81
SENIOR S, 2005	21 28	8,5	ACEI + Spiro	Nebi- wolol 10 mg 1 time per day	14	23	0	0
Val- HeFT, 2001	50 10	8,0	ACEI	Shaft- sartan 160 mg 2 times per day	13	0	35	33 †††
CHARM- Alter- native 2003	20 28	12,6	BB	Kande- sartan 32 mg 1 time per day	23	30	31	60
CHARM- Added 2003	25 48	10,6	ACEI + BB	Kande- sartan 32 mg 1 time per day	15	28	47	39
RALES, 1999	16 63	25	ACEI	Spiro- nolac- tone 25-50 mg 1 time per day	30	113	95	-
V- HeFT- 1, 1986	45 9	26,4	-	Hydra- lazin 75 mg 4 times per day. ISDN 40 mg 4 times per day	34	52	0	-
A- HeFT, 2004	10 50	9,0	ACEI + BB + spiro	Hydra- lazin 75 mg 3 times per day. ISDN 40 mg 3 times per day	-	40	80	-
GISSI- HF, 2008	69 75	9,0	ACEI + BB + spiro	Omega-3 poly- not on saturated new fat- acidic lots 1 g 1 time per day	9	18	0	-
DIG, 1997	68 00	11,0	ACEI	Digo- xin	0	0	79	73
HF- ACTION 2009	23 31	6,0	ACEI + BB + spiro	Physi- logical exercise opinions	11	0	-	-
COMPA- NION, 2004	92 5	19,0	ACEI + BB + spiro	PCT	19	38	-	87
CARE- HF, 2005	81 3	12,6	ACEI + BB + spiro	PCT	37	97	15 1	184
COMPA- NION, 2004	90 3	19,0	ACEI + BB + spiro	PCT- ICD	20	74	-	114
SCD- HeFT, 2005	16 76	7,0	ACEI + BB	ICD	23	-	-	-
R.E.M. ATCH, 2001	12 9	75	ACEI + spiro	Art- substantive ny LV	48	282	-	-

Notes.

* Excludes active-controlled studies (patients with preserved and low LV fraction were included in the CONSENSUS and SENIORS studies).

** In more than a third of patients, ACE inhibitor + beta blocker means that an ACE inhibitor is used in almost all patients, and a β-blocker in the majority. Most patients were also taking diuretics, and many were taking digoxin (with the exception of the DIG study). Spironolactone was used at the base dose in 5% of patients in the Val-HeFT study, 8% in MERIT-HF, 17% in CHARM-Added, 19% in SCD-HeFT, 20% in COPERNICUS, 24% in CHARM Alternative.

***Relative risk reduction in the primary endpoint. Hospitalization for CHF, patients hospitalized at least once due to worsening CHF; some patients were hospitalized several times.

† Stopped early to assess benefit.

†† Individual studies could not be conducted to assess the effect of treatment on these outcomes.

††† Primary endpoint, which also included treatment of HF with IV medications for 4 hours or more without hospitalization or resuscitation after cardiac arrest (both added nonsignificant numbers).

Designations: BB - β-blocker; RST-D - RST device with defibrillator; СС - cardiovascular; hospitalization - hospitalization; ISDN - isosorbide dinitrate; op. - published; spiro - spironolactone; VHS - ventricular assist system.

Research. A-HeFT (African-American Heart Failure Trial) - Study of heart failure in African-Americans;

CARE HF (Cardiac Resynchronization-Heart Failure) - Cardiac resynchronization for CHF;

COPERNICUS (Carvedilol Prospective Randomized Cumulative Survival) - Study on the use of carvedilol in patients with severe CHF;

CIBIS (Cardiac Insufficiency Bisoprolol Study) - Study on the use of bisoprolol in patients with CHF;

COMPANION (Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure) - Comparison of drug treatment, cardiac pacing and defibrillation for CHF;

CONSENSUS (Cooperative North Scandinavian Enalapril Survival Study) - Scandinavian study on the use of enalapril in patients with severe heart failure;

DIG (Digitalis Investigation Group) - Research on the use of digoxin;

GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico - Heart Failure) - Italian group for the study of MI survivors with HF;

HF-ACTION (Heart Failure- A Controlled Trial Investigating Outcomes Exercise TraiNing) - Controlled Study the effects of exercise on outcomes;

MERIT-HF (Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure) - A study on the use of a sustained-release form of metoprolol in the treatment of patients with CHF;

RALES (Randomized Aldactone Evaluation Study) - Study of the effectiveness of spironolactone (aldactone♠) in the complex treatment of patients with severe CHF;

REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) - Randomized trial of the use of mechanical assist systems for the treatment of CHF;

SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure) - Study of the effect of nebivolol on outcomes and readmission in elderly patients with CHF;

SOLVD-T (Studies of Left Ventricular Dysfunction Treatment) - A study on the use of enalapril in the treatment of patients with LV dysfunction and clinically significant CHF;

V-HeFT (Vasodilator Heart Failure Trial) - Study of the use of vasodilators in CHF;

Val-HeFT (Valsartan Heart Failure Trial) - Study of the use of valsartan in heart failure.

Modified (with permission): McMurray J.J., Pfeffer M.A. Heart failure // Lancet. - 2005. - Vol. 365. - P. 1877-1889.

John McMurray, Mark Petrie, Karl Swedberg, Michel Komajda, Stefan Anker and Roy Gardner

Heart failure

Reduced values impact indicators(eg, volume, work, strength and their indices adjusted for body surface area) are often associated with reduced myocardial contractility, but since these parameters are significantly dependent on pre- and afterload, these two variables also need to be determined. The dependence of stroke volume on preload was described more than 100 years ago by Otto Frank and E.N. Starling (since then it has been called the Frank-Starling mechanism). Based on the relationship between preload and stroke volume or systolic work, a curve can be constructed ventricular function, using the values ​​of systolic work at different levels preload, which can be expressed by ventricular EDV, EDP or end-diastolic wall tension.
On preload may be affected by volume loading (elevating the legs, infusing large volumes of fluid) or reducing it (occlusion with a balloon catheter of the vena cava).

LV afterload can be calculated from mean or end-systolic arterial or ventricular pressure or, more accurately, by calculating mean systolic, peak systolic and end-systolic wall stress. The most reliable method for determining LV contractility is to determine the pressure-to-volume ratio at end-systole (PSV/CVR; maximum elasticity), because this indicator is almost independent of pre- and afterload.

Slope of a given line ratio denotes LV contractility. The use of ventricular function curves in assessment is limited by the technical difficulties of making measurements in patients, changes that occur during the time required to take measurements, and varying interpretation because interpretation depends on the patient's sex, age, and afterload. Changes in RV DN can affect the position of the interventricular septum (IVS) and alter LV diastolic pressure, thereby altering the position of the ventricular function curve.

Left ventricular ejection fraction

There are several indexes global systolic function and LV contractility. Each index depends to some extent on pre- and afterload and can vary depending on the volume of the ventricle and myocardial mass. An important feature of their use in clinical practice is ease of use.

Ejection fraction- this is the ratio of MA to KDO. In most cases, it is calculated by the formula: EF = (EDV - ESV) / ​​EDV x 100 (%), where EF is the ejection fraction, EDV is the end-diastolic volume, ESV is the end-systolic volume.

Normal value of LVEF- 55-75% with cineangiography and echocardiography, but may be lower when determined by radionuclide angiography (45-65%). There are no gender differences observed. However, with age there is a tendency for EF to decrease. A sharp increase in afterload, as with a sharp increase in pressure load, leads to a decrease in EF to 45-50% in healthy people. However, the decrease in LVEF< 45% свидетельствует об ограниченной функции миокарда, независимо от условий нагрузки.

Wide application of PV in clinical practice is the result of a number of factors: ease of calculation, reproducibility using in various ways imaging and extensive literature evidence supporting its clinical benefit. This indicator has important prognostic value (both short- and long-term) in patients with various CVDs. However, it has its limitations, since it depends not only on myocardial contractility, but also on pre- and afterload, as well as on heart rate and contraction synchrony. This parameter is also global, and regional differences in contractility appear to be averaged.

Cardiac ejection fraction (EF) is an indicator by which the quantitative volume of blood ejected into the aorta during the conduction of an electrical impulse in the left ventricle is recorded.

Calculation this indicator occurs by the ratio of blood that enters the most large vessel, to the amount of blood that fills the left ventricle when its tissues weaken.

Cardiac ejection fraction

This value, simply calculated, stores a lot of information regarding the possibility of contractions of the heart muscle. Determining EF affects the prescribed medications for the heart, and EF is also used to predict life for people with heart failure.

The closer the EF values ​​are to normal, the better the heart beats. If the ejection fraction deviates below normal values, this indicates that the heart is unable to contract at a normal speed, which leads to problems with blood circulation.

In such a situation, you need to urgently consult a doctor for qualified help.

How is the PV calculated?

Calculating this fraction is not difficult, but it contains enough large number information about the heart muscle and its ability to contract normally.

In many cases, Doppler is used to determine ejection fraction. ultrasound examination hearts.

Calculation of PV.

The fraction indicator is calculated using the Teicholz formula or the Simpson formula. All calculations occur using a program that automatically produces a result depending on the amount of blood in the unstressed left ventricle, which is pushed into the aorta.

The main differences between the above formulas are:

• The Teicholtz formula determines the amount of blood ejected from the ventricle using M-modal ultrasound examination. This formula was patented by Teicholz in nineteen seventy-six.
• A small part of the ventricle at its base is examined; the length is not taken into account. False results, obtained by the formula, can occur during ischemic attacks, when contractions are disrupted in certain areas of the heart muscle.
• The program takes into account information about the volume in the relaxed and contracted left ventricle, producing the result automatically. This method used on equipment that is at the moment outdated;
• According to the Simpson formula, a quantitative two-dimensional ultrasound examination of the heart is performed, with the help of which more accurate results are obtained. Simpson's algorithm was patented by him in nineteen eighty-nine. The identical name for this algorithm is the disk method. At this study ejection fraction, all important areas of the heart muscle are examined.

Fact! Indicators of the results of the study of the same patient, according to different formulas, can fluctuate with a difference of ten percent.

What features does FV have?

The main features inherent in the ejection fraction are the following:

Norms

Individual indicators of ejection fraction are considered normal for a person, since for different age categories of people, its levels can vary. Also, the ejection fraction norm levels depend on the calculation formula and the equipment on which the analysis is carried out.

Average generally accepted normal value:

1. For the Simpson formula, it is from fifty to sixty percent, with an extreme lower limit of forty-five percent;
2. According to the Teicholz formula, the lowest limit is fifty-five percent. The lower bar indicator determines what percentage of blood needs to be squeezed into the aorta in order for it to reach the organs. required quantity oxygen.
3. In the case of heart failure, rates range from thirty-five to forty percent. In this condition, medication maintenance of the body or surgical intervention is necessary.
4. At levels below 35 percent, rapid complications and death may occur.

IN childhood ejection fraction values ​​are slightly increased. In newborns it is no less than sixty percent and can reach eighty. As the body develops and the child grows, the level of ejection fraction returns to normal.

With deviations, in most cases, there is a decline in the ejection fraction rather than an increase. Various pathological conditions affect the decrease in EF levels.

When the ejection fraction is below normal, it indicates that the myocardium cannot contract at a normal rate. It leads to impaired blood circulation in the body and oxygen starvation of organs. Initially, the brain suffers from hypoxia.

In some cases, the study results show ejection fraction limits above 60 percent. In many cases, they do not exceed 80 percent, since a healthy left ventricle cannot throw more blood into the aorta due to its structural characteristics.

Structure of the heart.

Also, with pathological enlargement of the heart muscle, an increased ejection fraction may indicate that the myocardium cannot restore progressive heart failure and is trying to throw the greatest amount of blood into the aorta.

As heart failure progresses, the ejection fraction decreases. That is why it is important to monitor deviations in EF in one direction or another, and immediately contact the hospital for examination.

Why is the decline happening?

The initial stages of progression of heart disease do not affect the ejection fraction. This happens because the heart muscle tries to adapt to the changes (the layer of the myocardium increases, its contractions become more frequent, and the small vessels of the heart are rebuilt). Find out what cardiac muscle is.

As the disease progresses, the muscle wears out more and more, which leads to deviations in functional abilities that lead to structural disorders. All this disrupts the amount of blood ejected by the left ventricle into the aorta, causing disruptions in blood circulation.

Such deviations are provoked by everything that negatively affects the heart muscle:

Factor	Characteristic diseases
Decline in normal blood flow through the coronary arteries	Various forms of angina;
	Death of the heart muscles;
	Formation of scars on the walls of the myocardium;
	A form of ischemic attack that occurs without symptoms;
	Expansion of the walls of the stomach;
	Constant increase in pressure.
Diseases of infectious and inflammatory origin	Myocarditis (muscular membrane affected);
	Endocarditis (changes in the inner lining);
	Pericarditis (disease of the heart sac).
Structural changes in cardiac muscle tissue	All types of primary myocardial lesions not associated with inflammatory, tumor and ischemic excitations;
	Deviation of metabolism in the myocardium, which leads to thinness of the heart walls.
Deviations in the structure of the heart, formed in the womb;
Disturbances in the structure of the heart due to damage by rheumatic diseases;
Increased pressure in the pulmonary circulation.
Pathological conditions of blood vessels	Inflammatory processes on the walls of blood vessels, which lead to their deformation;
	Congenital abnormalities in the structure of the heart (improper arrangement of blood vessels, large narrowing of the aorta, improper connection of large vessels);
	Expansion of the aorta, provoked by deformation of the walls of blood vessels;
	Aortic detachment;
	Deposition of atherosclerotic plaques on the walls;
	Narrowing of the aorta;
	Thrombosis of pulmonary vessels.
Failure in the endocrine system	Failure in the production of thyroid hormones;
	Failure of glucose absorption in the body;
	Presence of diabetes mellitus;
	Tumors in the adrenal glands or pancreas;
	Excessive amount of excess weight.
Effect of toxic agents	Alcoholic drinks;
	Drinks containing high levels of caffeine ( strong tea, coffee, energy drinks, etc.);
	Cigarettes;
	Drug use;
	Taking certain medications (cardiac glycosides).

Symptoms of deviation

Impairment of physical and labor activity are the main consequences of violation of the normal boundaries of the cardiac ejection fraction. There is a significant deterioration in the condition, in which everyday activities become difficult to perform.

In most cases, the following symptoms appear in case of circulatory disorders:

If one of the above symptoms is detected, you must immediately go to the hospital for examination.

How are low scores treated?

Since a decrease in ejection fraction is not separate disease, but is only provoked by initial diseases, then a qualified doctor should send the patient for additional hardware examinations that will help determine the root cause of the decrease in EF.

Depending on the cause that provoked the decrease in ejection fraction, treatment may be:

1. Medication;
2. Surgical.

For ischemic attacks, it is necessary to take nitroglycerin to normalize EF, and for hypertension - antihypertensive drugs etc.

It is important to understand that as EF decreases, heart failure progresses, which requires compliance with all doctor’s recommendations.

Drugs

The main drugs that affect the increase in ejection fraction are listed in the table below.

Groups of medications	Characteristic
ACE inhibitors (Enalapril, Ramipril, Captopril)	Dilate blood vessels;
	Improves nutrition of myocardial tissue;
	Increases the resistance of the heart muscle to stress;
	Increases myocardial performance
Beta blockers (Nebivolol, Bisoprolol, Metoprolol)	Reduces the need for cardiac tissue to be saturated with oxygen and beneficial elements;
	Reduce heart rate;
	Reduces rapid wear and tear of the heart muscle;
	Increase the number of zones that contract the heart muscle.
Aldosterone receptor antagonists (Eplerenone, Spironolactone)	Restoring normal levels of potassium and sodium in the blood;
	Removing fluids from the body, which reduces the load on the heart muscle.
Diuretics (Torasemide, Indapamide, Hypothiazide)	Remove fluid accumulations;
	Reduces the impact on the heart muscle.
Cardiac glycosides (Digoxin, Strophanthin)	Improvement of myocardial contractions;
	If the functionality of the heart muscle is impaired, the conduction of electrical impulses is restored.
Angiotensin 2 receptor antagonists (Olmesartan, Valsartan, Candesartan)	Have the same effect as ACE inhibitors, but effective force is much more.

Additional agents that can improve ejection fraction in some cases include the following.

There are also groups of drugs that are auxiliary and are prescribed in

in certain situations, in combination with the main therapy.

Drug groups	Characteristic
Peripheral vasodilators (Nitroglycerin, Sodium, Nitroprusside, Apressin)	Significantly reduces the load on the ventricles;
	Helps improve blood circulation in the vessels of the heart.
Blockers calcium channels (Nifedipine, Verapamil, Nimodipine)	Helps increase the lumen of heart vessels, which leads to greater consumption nutrients fabrics.
Antiplatelet agents (Plavix, Aspirin)	Prevents the formation of blood clots.
Drugs against arrhythmia (Amiodarone, Diltiazem, Disopyramide)	Restores heart rhythm when it is disrupted.

Surgical intervention

If the ejection fraction is abnormal, surgical interventions may be used. View surgery depends on individual indicators and pathological conditions patient.

In most cases, the following surgical methods are used:

• Implantation of a defibrillator or cardiac pacemaker. By open surgery a device is installed on the heart, which, in case of heart rhythm disturbances, restores normal blood circulation by electrically acting on the heart;

Heart stimulator.

• Impact on different rhythms of the ventricles and atria. They achieve a slowdown in ventricular contractions using artificial heart block. This restores the necessary flow of blood entering the ventricles.

What will help improve the condition, in addition to the main course of treatment?

For complex treatment The following recommendations must be adhered to. Only by observing them and the correctly prescribed method of treatment.

Long-term normalization of ejection fraction can be achieved:

• Normalize your daily routine by setting aside time for good sleep(at least 8 hours);
• Moderate exercise. Required for speedy recovery myocardium damaged by underlying causes. It is important not to overdo it so as not to damage the heart muscle;
• It is recommended to engage in light sports (physical education, swimming, aerobics, etc.), and also devote time to hiking at least one hour a day;
• Avoid strenuous physical activity;
• Eat right. And also consume more food rich in iron;
• Massage is recommended to improve blood circulation and relieve swelling;
• Avoid stressful situations. Strong emotional stress (both positive and negative), constant stress, depression - all this affects the deformation of the myocardium due to its overstrain;
• Maintain normal water balance. Drink at least one and a half liters of pure drinking water per day;
• Reduce salt intake;
• Get rid of bad habits. Toxins supplied with alcoholic beverages and cigarettes irritate the myocardium.

You can take blood thinners:

• Willow bark - prevents clots from forming, thinning the blood;
• Red clover. Concentrates salicylic and coumaric acids. Regular use of this decoction reduces the thickness of the blood;
• Meadowsweet. Contains the same acids as clover, plus ascorbic acid. Renders positive influence on the body, strengthening blood vessels, fighting rheumatism, and killing bacteria;
• Sweet clover yellow. Contains a high concentration of coumarins, which slow down clotting;
• Hawthorn is a fairly common plant. Its leaves strengthen blood vessels, have a positive effect on the heart, and also thin the blood. IN medical purposes used as an alcohol tincture or extract;
• Rakita. Bush plant, with a high concentration of flavonoids and salicylates. Prevents inflammation and tones, inhibits clotting processes and strengthens blood vessels. For treatment purposes, the bark is used;
• Ginko Biloba. The most powerful antioxidant, dilates blood vessels, preventing blood clots from forming. Positively affects blood flow in the brain, improving memory and attention.

Also sometimes they use means to calm the body, since under emotional and nervous influence aggravated complications of heart disease.

These include:

There are also the following methods to calm the nervous system:

• Garlic with milk. To prepare, you need to grate a clove of garlic into milk and consume half an hour before breakfast;
• Honey with water. Dissolve 50 grams of honey in half a liter of water and drink in 4 doses throughout the day.

Attention! Use of any means traditional medicine requires prior consultation with the attending physician. Taking them on your own can lead to complications.

Prevention

In order to support healthy condition body, you should adhere to the following recommendations:

• If available overweight, it is recommended to reset it;
• Avoid stressful situations and nervous tension;
• Stick to a daily routine good rest and sleep;
• Monitor blood pressure readings;
• Eat less animal fats and more plant fats;
• Eat a balanced diet;
• Get rid of a sedentary lifestyle, play sports;
• Stop smoking and drinking alcohol.

The right image life.

What is the prognosis for deviations in EF?

If the ejection fraction drops to forty percent, then the risk of death from sudden cardiac arrest is up to fifteen percent. If it drops to 35 percent, the risk is up to 25 percent. If indicators fall below these levels, then the risk increases proportionally.

It is not possible to completely cure ejection fraction abnormalities, but early therapy will help prolong life with normal life processes.

If any symptoms or already diagnosed diseases are detected, you should be constantly monitored by a cardiologist and undergo regular tests. This is done to prevent the progression of complications.

DO NOT self-medicate and be healthy!

The concept of “ejection fraction” is of interest not only to specialists. Any person who is undergoing examination or treatment for heart and vascular diseases may encounter the concept of ejection fraction. Most often, the patient hears this term for the first time while undergoing an ultrasound examination of the heart - dynamic echography or X-ray contrast examination. In Russia, thousands of people require imaging examinations every day. Ultrasound examination of the heart muscle is often performed. It is after such an examination that the patient is faced with the question: ejection fraction - what is the norm? You can get the most accurate information from your doctor. In this article we will also try to answer this question.

Heart diseases in our country

Diseases cardiovascular system in civilized countries they are the first cause of death for the majority of the population. In Russia, coronary heart disease and other diseases circulatory system extremely widespread. After 40 years, the risk of getting sick becomes especially high. Risk factors cardiovascular problems are male gender, smoking, sedentary lifestyle, disorders carbohydrate metabolism, high cholesterol, high blood pressure and some others. If you have several risk factors or complaints from the cardiovascular system, then it is worth contacting for examination medical care see a general practitioner or cardiologist. Using special equipment, the doctor will determine the size of the left ventricular ejection fraction and other parameters, and, therefore, the presence of heart failure.

What examinations can a cardiologist prescribe?

The doctor may be alerted by the patient's complaints of pain in the heart, pain in the chest, interruptions in heart function, rapid heartbeat, shortness of breath during exercise, dizziness, fainting states, swelling in the legs, fatigue, decreased performance, weakness. The first tests are usually an electrocardiogram and a biochemical blood test. Next, Holter monitoring of the electrocardiogram, bicycle ergometry and ultrasound examination of the heart can be performed.

What studies will show ejection fraction?

Ultrasound examination of the heart, as well as radiopaque or isotope ventriculography will help obtain information about the ejection fraction of the left and right ventricles. Ultrasound examination is the cheapest, safest and least burdensome for the patient. Even the simplest ultrasound machines can give an idea of ​​cardiac ejection fraction.

Cardiac ejection fraction

Ejection fraction is a measure of how much work the heart does with each beat. The ejection fraction is usually called the percentage of the volume of blood ejected into the vessels from the ventricle of the heart during each contraction. If there were 100 ml of blood in the ventricle, and after the heart contracted, 60 ml entered the aorta, then we can say that the ejection fraction was 60%. When you hear the term “ejection fraction,” we are usually talking about the function of the left ventricle of the heart. Blood from the left ventricle enters the systemic circulation. It is left ventricular failure that most often leads to the development of the clinical picture of heart failure. The ejection fraction of the right ventricle can also be assessed with ultrasound examination of the heart.

Ejection fraction - what is the norm?

A healthy heart, even at rest, pumps more than half of the blood from the left ventricle into the vessels with each beat. If this figure is significantly less, then we're talking about about heart failure. This condition can be caused by myocardial ischemia, cardiomyopathy, heart defects and other diseases. So, the normal left ventricular ejection fraction is 55-70%. A value of 40-55% indicates that the ejection fraction is below normal. An indicator of less than 40% indicates the presence of heart failure. When the left ventricular ejection fraction decreases to less than 35%, the patient has high risk occurrence of life-threatening interruptions in heart function.

Low ejection fraction

Now that you know your ejection fraction standards, you can evaluate how your heart is working. If your left ventricular ejection fraction is lower than normal on echocardiography, you will need to see your doctor immediately. It is important for the cardiologist not only to know that heart failure exists, but also to find out the cause of this condition. Therefore, after an ultrasound examination, other types of diagnostics can be carried out. A low ejection fraction may predispose you to malaise, swelling and shortness of breath. Currently, a cardiologist has tools to treat diseases that cause low ejection fraction. The main thing is constant outpatient monitoring of the patient. In many cities, specialized cardiology clinics have been organized for free dynamic monitoring of patients with heart failure. A cardiologist may prescribe conservative treatment with pills or surgical procedures.

Methods for treating low cardiac ejection fraction

If the cause of low cardiac ejection fraction is heart failure, then appropriate treatment will be required. The patient is recommended to limit fluid intake to less than 2 liters per day. The patient will also have to stop using table salt in food. The cardiologist may prescribe medications: diuretics, digoxin, ACE inhibitors or beta blockers. Diuretic medications somewhat reduce the volume of circulating blood, and therefore the amount of work done by the heart. Other drugs reduce the oxygen demand of the heart muscle, making its function more effective, but less expensive.

Plays an increasingly important role surgical treatment reduced cardiac ejection fraction. Operations have been developed to restore blood flow in the coronary vessels during coronary disease hearts. Surgery is also used to treat severe heart valve defects. According to indications, artificial cardiac pacemakers can be installed to prevent arrhythmia in the patient and eliminate fibrillation. Cardiac interventions are long-term heavy operations, requiring extremely high qualifications from the surgeon and anesthesiologist. Therefore, such operations are usually performed only in specialized centers in large cities.

Symptoms of indicators going beyond normal limits, principles of treatment and prognosis.

Ejection fraction (EF) is the ratio of stroke volume (blood that enters the aorta during one contraction of the heart muscle) to the end-diastolic volume of the ventricle (blood that accumulates in the cavity during the period of relaxation, or diastole, of the myocardium). The resulting value is multiplied by 100% to obtain the final value. That is, this is the percentage of blood that the ventricle pushes out during systole from the total volume of fluid it contains.

The indicator is calculated by a computer during an ultrasonographic examination of the heart chambers (echocardiography or ultrasound). It is used only for the left ventricle and directly reflects its ability to perform its function, that is, to ensure adequate blood flow throughout the body.

Under conditions of physiological rest, the normal value of EF is considered to be 50–75%; during physical activity in healthy people it increases to 80–85%. There is no further increase, since the myocardium cannot eject all the blood from the ventricular cavity, which will lead to cardiac arrest.

In medical terms, only a decrease in the indicator is assessed - this is one of the main criteria for the development of a decrease in cardiac performance, a sign of myocardial contractile failure. This is indicated by an EF value below 45%.

Such insufficiency poses a great danger to life - a small supply of blood to the organs disrupts their functioning, which ends in multiple organ dysfunction and ultimately leads to the death of the patient.

Considering that the reason for the decrease in left ventricular ejection volume is its systolic failure (as the outcome of many chronic pathologies heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out to support the myocardium and aimed at stabilizing the condition at one level.

Cardiologists and therapists are involved in monitoring and selecting therapy for patients with low ejection fraction. Under certain conditions, the assistance of a vascular or endovascular surgeon may be required.

Features of the indicator

1. The ejection fraction does not depend on the gender of the person.
2. With age, a physiological decline in this indicator is noted.
3. A low EF may be an individual norm, but a value of less than 45% is always considered pathological.
4. All healthy people have an increase in value with an increase in heart rate and blood pressure levels.
5. The normal indicator when measuring by radionucleide angiography is considered to be 45–65%.
6. The Simpson or Teicholz formulas are used for measurement; normal values, depending on the method used, range up to 10%.
7. A critical level of reduction of 35% or less is a sign of irreversible changes in myocardial tissue.
8. For children in the first years of life, higher rates of 60–80% are typical.
9. The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decline

On initial stages In any disease, the ejection fraction remains normal due to the development of adaptation processes in the myocardium (thickening of the muscle layer, increased work, restructuring of small blood vessels). As the disease progresses, the heart's capacity becomes exhausted, the contractility of muscle fibers becomes impaired, and the volume of ejected blood decreases.

Such disorders are caused by all influences and diseases that have a negative effect on the myocardium.

Acute myocardial infarction

Scar changes in cardiac tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Ventricular wall aneurysm

Endocarditis (changes in the inner lining)

Pericarditis (heart sac disease)

Congenital disorders normal structure or defects (violation of the correct location, significant reduction in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage to the walls of the aorta and its branches by cells of their own immunity)

Thromboembolism of pulmonary vessels

Diabetes mellitus and impaired glucose absorption

Hormone-active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulant drugs

Symptoms of a decrease in indicator

Low ejection fraction is one of the main criteria for cardiac dysfunction, so patients are forced to significantly limit their work and physical activity. Often, even simple housework causes a deterioration in the condition, which forces you to spend most of your time sitting or lying in bed.

Manifestations of a decrease in the indicator are distributed by frequency of occurrence from the most frequent to the rarer:

• significant loss of strength and fatigue from usual activities;
• breathing disorders such as an increase in frequency, up to attacks of suffocation;
• breathing problems worsen when lying down;
• collapsed states and loss of consciousness;
• changes in vision (darkening in the eyes, “spots”);
• pain syndrome in the projection of the heart of varying intensity;
• increased number of heart contractions;
• swelling of the legs and feet;
• accumulation of fluid in the chest and abdomen;
• gradual increase in liver size;
• progressive weight loss;
• episodes of impaired coordination and gait;
• periodic decrease in sensitivity and active mobility in the limbs;
• discomfort, moderate pain in the projection of the abdomen;
• unstable stool;
• attacks of nausea;
• vomiting with blood;
• blood in stool.

Treatment if the indicator decreases

An ejection fraction of less than 45% is a consequence of changes in the functionality of the heart muscle against the background of progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in myocardial tissue, and the possibility complete cure there is no longer any talk. All therapeutic measures are aimed at stabilization pathological changes at their early stage and improving the patient’s quality of life at the later stage.

The treatment complex includes:

• carrying out correction of the underlying pathological process;
• treatment of left ventricular failure.

This article is devoted directly to left ventricular ejection fraction and the types of its disorders, so further we will talk only about this part of the treatment.

Cardiac ejection fraction

When Inge Elder proposed using ultrasound to visualize human organs in the 1950s, he was not mistaken. Today, this method plays an important and sometimes key role in the diagnosis of heart diseases. Let's talk about decoding its indicators.

1 Important diagnostic method

Ultrasound examination of the heart

Echocardiographic examination of the cardiovascular system is very important and also quite accessible method diagnostics In some cases, the method is the “gold standard”, allowing one or another diagnosis to be verified. In addition, the method makes it possible to identify hidden heart failure that does not manifest itself during intense physical activity. Echocardiography data ( normal indicators) may vary slightly depending on the source. We present the guidelines proposed by the American Association of Echocardiography and the European Association of Cardiovascular Imaging in 2015.

2 Ejection fraction

Healthy ejection fraction and pathological (less than 45%)

Ejection fraction (EF) has important diagnostic value, as it allows assessing the systolic function of the LV and right ventricles. Ejection fraction is the percentage of blood volume that is expelled into the vessels from the right and left ventricles during systole. If, for example, out of 100 ml of blood, 65 ml of blood entered the vessels, as a percentage this will be 65%.

Left ventricle. The normal left ventricular ejection fraction for men is ≥ 52%, for women - ≥ 54%. In addition to the LV ejection fraction, the LV shortening fraction is also determined, which reflects the state of its pumping (contractile) function. The norm for the shortening fraction (SF) of the left ventricle is ≥ 25%.

Low left ventricular ejection fraction may occur with rheumatic heart disease, dilated cardiomyopathy, myocarditis, myocardial infarction, and other conditions that lead to heart failure (weakness of the heart muscle). A decrease in left ventricular EF is a sign of LV heart failure. Left ventricular FU decreases in heart diseases that lead to heart failure - myocardial infarction, heart defects, myocarditis, etc.

Right ventricle. The normal ejection fraction for the right ventricle (RV) is ≥ 45%.

3 Dimensions of heart chambers

The dimensions of the heart chambers are a parameter that is determined in order to exclude or confirm overload of the atria or ventricles.

Left atrium. The normal left atrium (LA) diameter in mm for men is ≤ 40, for women ≤ 38. An increase in the diameter of the left atrium may indicate heart failure in the patient. In addition to the LA diameter, its volume is also measured. The normal LA volume for men in mm3 is ≤ 58, for women ≤ 52. LA size increases with cardiomyopathies, defects mitral valve, arrhythmias (heart rhythm disturbances), congenital heart defects.

Right atrium. For the right atrium (RA), as well as for the left atrium, the dimensions (diameter and volume) are determined by echocardiography. Normally, the diameter of the PP is ≤ 44 mm. Right atrium volume is divided by body surface area (BSA). For men, the normal ratio of PP/PPT volume is ≤ 39 ml/m2, for women - ≤33 ml/m2. The size of the right atrium may increase with insufficiency of the right heart. Pulmonary hypertension, pulmonary embolism, chronic obstructive pulmonary disease and other diseases can cause the development of right atrial insufficiency.

ECHO Cardiography (ultrasound of the heart)

Left ventricle. The ventricles have their own parameters regarding their sizes. Since it is of interest to the practicing physician functional state ventricles in systole and diastole, there are corresponding indicators. Main size indicators for the left ventricle:

1. Diastolic size in mm (men) - ≤ 58, women - ≤ 52;
2. Diastolic size/PPT (men) - ≤ 30 mm/m2, women - ≤ 31 mm/m2;
3. End-diastolic volume (men) - ≤ 150 ml, women - ≤ 106 ml;
4. End-diastolic volume/BSA (men) - ≤ 74 ml/m2, women - ≤61 ml/m2;
5. Systolic size in mm (men) - ≤ 40, women - ≤ 35;
6. End systolic volume (men) - ≤ 61 ml, women - ≤ 42 ml;
7. End-systolic volume/BSA (men) - ≤ 31 ml/m2, women - ≤ 24 ml/m2;

Indicators of diastolic and systolic volume and size may increase with myocardial diseases, heart failure, as well as with congenital and acquired heart defects.

Myocardial mass indicators

The mass of the LV myocardium may increase as its walls thicken (hypertrophy). The cause of hypertrophy can be various diseases of the cardiovascular system: arterial hypertension, mitral and aortic valve defects, hypertrophic cardiomyopathy.

Right ventricle. Basal diameter - ≤ 41 mm;

End-diastolic volume (EDV) RV/APT (men) ≤ 87 ml/m2, women ≤ 74 ml/m2;

End systolic volume (ESV) of the RV/PPT (men) - ≤ 44 ml/m2, women - 36 ml/m2;

The thickness of the pancreas wall is ≤ 5 mm.

Interventricular septum. The thickness of the IVS in men in mm is ≤ 10, in women - ≤ 9;

4 Valves

To assess the condition of the valves in echocardiography, parameters such as valve area and mean pressure gradient are used.

5 Vessels

Blood vessels of the heart

Pulmonary artery. Pulmonary artery (PA) diameter - ≤ 21 mm, PA acceleration time - ≥110 ms. A decrease in the lumen of the vessel indicates stenosis or pathological narrowing of the pulmonary artery. Systolic pressure ≤ 30 mm Hg, mean pressure ≤ mm Hg; An increase in pressure in the pulmonary artery that exceeds acceptable limits indicates the presence of pulmonary hypertension.

Inferior vena cava. Diameter of the inferior vena cava (IVC) - ≤ 21 mm; An increase in the diameter of the inferior vena cava can be observed with a significant increase in the volume of the right atrium (RA) and a weakening of its contractile function. This condition can occur with narrowing of the right atrioventricular orifice and with tricuspid valve (TC) insufficiency.

More detailed information about the remaining valves can be found in other sources, large vessels, as well as calculations of indicators. Here are some of them that were missing above:

1. Ejection fraction according to Simpson is the norm ≥ 45%, according to Teicholz - ≥ 55%. Simpson's method is used more often because it is more accurate. According to this method, the entire LV cavity is divided conditionally into a certain number of thin disks. The EchoCG operator makes measurements at the end of systole and diastole. The Teicholtz method for determining ejection fraction is simpler, but in the presence of asynergic zones in the LV, the obtained data on ejection fraction are inaccurate.
2. The concept of normokinesis, hyperkinesis and hypokinesis. Such indicators are assessed by the amplitude of the interventricular septum and the posterior wall of the LV. Normally, fluctuations of the interventricular septum (IVS) are within the range of 0.5-0.8 cm, for the posterior wall of the LV - 0.9 - 1.4 cm. If the amplitude of movements is less than the indicated figures, they speak of hypokinesis. In the absence of movement - akinesis. There is also the concept of dyskinesia - wall movement with a negative sign. With hyperkinesis, indicators exceed normal values. Asynchronous movement of the LV walls may also occur, which often occurs with intraventricular conduction disorders, atrial fibrillation (AF), and an artificial pacemaker.

Cardiac output: norm and causes of deviation

When a patient receives test results, he tries to figure out on his own what each value obtained means and how critical the deviation from the norm is. The cardiac output indicator is of important diagnostic value, the norm of which indicates a sufficient amount of blood ejected into the aorta, and a deviation indicates impending heart failure.

Cardiac ejection fraction assessment

When a patient comes to the clinic with complaints of heart pain, the doctor will prescribe a full diagnosis. A patient who is encountering this problem for the first time may not understand what all the terms mean, when certain parameters are increased or decreased, how they are calculated.

Cardiac ejection fraction is determined with the following patient complaints:

A biochemical blood test and an electrocardiogram will be indicative for the doctor. If the data obtained is not enough, ultrasound, Holter monitoring of the electrocardiogram, and bicycle ergometry are performed.

The ejection fraction is determined at next studies hearts:

• isotope ventriculography;
• X-ray contrast ventriculography.

Ejection fraction is not a difficult indicator to analyze; even the simplest ultrasound machine shows the data. As a result, the doctor receives data showing how efficiently the heart works with each beat. During each contraction, a certain percentage of blood is ejected from the ventricle into the vessels. This volume is referred to as the ejection fraction. If 60 cm3 of 100 ml of blood in the ventricle entered the aorta, then cardiac output was 60%.

The work of the left ventricle is considered indicative, since from the left part of the heart muscle blood enters the systemic circulation. If malfunctions in the left ventricle are not detected in time, there is a risk of heart failure. A reduced cardiac output indicates the inability of the heart to contract at full strength, therefore the body is not provided with the necessary volume of blood. In this case, the heart is supported with medication.

The following formula is used for calculation: stroke volume multiplied by heart rate. The result will show how much blood is pumped out by the heart in 1 minute. The average volume is 5.5 liters.

Formulas for calculating cardiac output have names.

1. Teicholz formula. The calculation is performed automatically by a program into which data on the final systolic and diastolic volume of the left ventricle is entered. The size of the organ also matters.
2. Simpson's formula. The main difference is the possibility of getting into the slice of the circumference of all parts of the myocardium. The study is more revealing; it requires modern equipment.

Data obtained using two different formulas may differ by 10%. The data is indicative for diagnosing any disease of the cardiovascular system.

Important nuances when measuring the percentage of cardiac output:

• the result is not affected by the gender of the person;
• how older man, the lower the rate of the indicator;
• a pathological condition is considered to be below 45%;
• a decrease in the indicator of less than 35% leads to irreversible consequences;
• the reduced rate may be individual feature(but not lower than 45%);
• the indicator increases with hypertension;
• in the first few years of life, in children the emission rate exceeds the norm (60-80%).

Normal EF values

Normally, more blood passes through the left ventricle, regardless of whether the heart is currently busy or at rest. Determining the percentage of cardiac output allows for timely diagnosis of heart failure.

Normal cardiac ejection fraction values

The cardiac output rate is 55-70%, reduced rate read 40-55%. If the rate drops below 40%, heart failure is diagnosed; a rate below 35% indicates possible irreversible life-threatening heart failure in the near future.

Exceeding the norm is rare, since the heart is physically unable to expel more blood volume into the aorta than required. The indicator reaches 80% in trained people, in particular, athletes, people leading a healthy, active image life.

An increase in cardiac output may indicate myocardial hypertrophy. At this moment, the left ventricle tries to compensate initial stage heart failure and pushes blood out with greater force.

Even if the body is not affected by external irritating factors, it is guaranteed that 50% of the blood will be expelled with each contraction. If a person is concerned about his health, then after the age of 40, it is recommended to undergo an annual physical examination with a cardiologist.

The correctness of the prescribed therapy also depends on determining the individual threshold. An insufficient amount of processed blood causes a deficiency of oxygen supply in all organs, including the brain.

The following pathologies lead to a decrease in cardiac output:

• coronary heart disease;
• myocardial infarction;
• heart rhythm disturbances (arrhythmia, tachycardia);
• cardiomyopathy.

Each pathology of the heart muscle affects the functioning of the ventricle in its own way. During coronary heart disease, blood flow decreases; after a heart attack, the muscles become covered with scars that cannot contract. Rhythm disturbances lead to deterioration of conductivity, rapid wear and tear of the heart, and cardiomyopathy leads to an increase in muscle size.

At the first stage of any disease, the ejection fraction does not change much. The heart muscle adapts to new conditions, the muscle layer grows, small muscles are rebuilt blood vessels. Gradually, the capacity of the heart is exhausted, the muscle fibers are weakened, and the volume of absorbed blood decreases.

Other diseases that reduce cardiac output:

• angina pectoris;
• hypertension;
• aneurysm of the ventricular wall;
• infectious inflammatory diseases(pericarditis, myocarditis, endocarditis);
• myocardial dystrophy;
• cardiomyopathy;
• congenital pathologies, violation of the structure of the organ;
• vasculitis;
• vascular pathologies;
• hormonal imbalances in the body;
• diabetes mellitus;
• obesity;
• gland tumors;
• intoxication.

A low ejection fraction indicates serious cardiac pathologies. Having received a diagnosis, the patient needs to reconsider his lifestyle, exclude excessive loads on the heart. Emotional disorders can cause the condition to worsen.

The patient complains of the following symptoms:

• increased fatigue, weakness;
• feeling of suffocation;
• breathing disorders;
• difficulty breathing when lying down;
• visual disturbances;
• loss of consciousness;
• heart pain;
• increased heart rate;
• swelling of the lower extremities.

At more advanced stages and with the development of secondary diseases, the following symptoms occur:

• decreased sensitivity of the limbs;
• liver enlargement;
• lack of coordination;
• weight loss;
• nausea, vomiting, blood in stool;
• abdominal pain;
• accumulation of fluid in the lungs and abdominal cavity.

Even if there are no symptoms, this does not mean that the person does not have heart failure. Conversely, pronounced symptoms listed above will not always result in a reduced percentage of cardiac output.

Ultrasound - norms and interpretation

Ultrasound examination of the heart

An ultrasound examination provides several indicators by which the doctor judges the condition of the heart muscle, in particular the functioning of the left ventricle.

1. Cardiac output, normal 55-60%;
2. The size of the atrium of the right chamber, the norm is 2.7-4.5 cm;
3. Aortic diameter, normal 2.1-4.1 cm;
4. The size of the atrium of the left chamber, the norm is 1.9-4 cm;
5. Stroke volume, normsm.

It is important to evaluate not each indicator separately, but the overall clinical picture. If there is a deviation from the norm up or down in only one indicator, you will need additional research to determine the cause.

Immediately after receiving the ultrasound results and determining a reduced percentage of cardiac output, the doctor will not be able to determine a treatment plan and prescribe medications. The cause of the pathology should be dealt with, and not with the symptoms of reduced ejection fraction.

Therapy is selected after full diagnostics, definition of the disease and its stage. In some cases this drug therapy, sometimes surgery.

First of all, medications are prescribed to eliminate the root cause of the reduced ejection fraction. A mandatory part of treatment is taking drugs that increase myocardial contractility (cardiac glycosides). The doctor selects the dosage and duration of treatment based on test results; uncontrolled use can lead to glycoside intoxication.

Heart failure is treated not only with pills. The patient must control the drinking regime; the daily volume of liquid consumed should not exceed 2 liters. It is necessary to remove salt from the diet. Additionally, diuretics, beta-blockers, ACE inhibitors, and Digoxin are prescribed. Medicines that reduce the heart's need for oxygen will help alleviate the condition.

Restore blood flow in case of coronary disease and eliminate severe heart defects. surgical methods. For arrhythmia can be installed artificial driver hearts. The operation is not performed if the percentage of cardiac output drops below 20%.

Prevention

Preventive measures are aimed at improving the condition of the cardiovascular system.

1. Active lifestyle.
2. Sports activities.
3. Proper nutrition.
4. Quitting bad habits.
5. Rest on fresh air.
6. Relief from stress.

Causes of abnormal ejection fraction and treatment methods

Cardiac ejection fraction (EF) is a value that determines the efficiency of the heart. Basically, this indicator is characterized by the amount of blood that, during the contraction period, is pushed into the aortic space by the left ventricle. In a calm state, the ventricle contains blood from the left atrium inside; at the moment of contraction, it throws part of it into the vessels. Left ventricular ejection fraction is the percentage ratio of the amount of blood pushed into the aorta to the volume of blood in the left ventricle, which is in a relaxed state. The volume of blood ejected, expressed as a percentage, is called the ejection fraction.

Such a concept as ejection fraction determines the functionality of the left ventricle, since it ejects blood into the systemic circulation. As the ejection fraction decreases, heart failure develops.

Indications for prescribing ejection fraction studies may include patient complaints:

• heart pain;
• chest pain;
• interruptions in heart activity;
• tachycardia;
• fainting and dizziness;
• weakness;
• decreased performance;
• swelling of the limbs.

First, as a rule, an electrocardiogram and blood test are prescribed, then Holter monitoring of the electrocardiogram, bicycle ergometry and ultrasound of the heart may be prescribed.

How is PV calculated?

Ejection fraction is easy to calculate and contains sufficient information about the ability of the myocardium to contract. The use of drugs in the treatment of patients with cardiovascular failure depends on this indicator. Studies such as cardiac ultrasound with Doppler sonography are widely used to determine the value of left ventricular ejection fraction.

The ejection fraction can be determined using the Teicholtz formula or the Simpson method:

• Using M-modal echocardiography (parasternal access), the ventricular ejection fraction is determined using the Teicholz formula (Teichholz L. E., 1976). A small part of the ventricle at the base is subject to study; its length is not taken into account. The formula gives inaccurate results when examining patients with ischemia, when there are areas with impaired local contractility. Using information about the systolic and diastolic volume of the left ventricle and its dimensions, the program automatically calculates the result. The method is used on outdated equipment.
• Quantitative two-dimensional echocardiography (apical access) is a method that is more accurate compared to the previous one. In modern ultrasound diagnostic clinics, they use the Simpson algorithm (Simpson J. S., 1989) or, as it is also called, the disc method. All significant areas of the myocardium are included in the field of view during the study.

The difference between ejection fraction studies can vary by up to 10%.

Normal fraction emission

At the moment of contraction, the human heart pushes more than 50% of the blood into the blood supply. Heart failure occurs when the level of ejection fraction decreases. Progressive failure of myocardial contractile function may serve as the basis for the development of other changes in the internal organs.

The ejection fraction rate is 55–70%. At 40–55% we can say that EF is below normal. Interruptions in the functioning of the heart occur when the indicator drops to 35%: heart failure occurs. To prevent a decrease in EF, it is recommended to visit a cardiologist at least once a year, and for people over forty, this is prerequisite. When examining patients with heart pathologies, it is important to determine the minimum value of the left ventricular ejection fraction. The choice of treatment tactics for the patient depends on this.

Why might the EF level be overestimated?

If the test results show an indicator of 60% or more, this indicates an overestimated level of ejection fraction. The most high value can reach 80%; the left ventricle is simply unable to pump more blood into the vessels due to its characteristics. Typically, such results are typical for healthy people without other heart pathologies. And for athletes with a trained heart, in whom the heart muscle, contracting with significant force, is able to push out more blood than usual.

Cardiomyopathy or hypertension can trigger the development of myocardial hypertrophy. In such patients, the heart muscle can still cope with heart failure and compensates for it, trying to expel blood into the systemic circulation. This can be judged by observing an increase in left ventricular EF.

As heart failure progresses, the ejection fraction slowly decreases. For patients suffering from chronic heart failure, periodic echocardioscopy is extremely important to monitor the decrease in EF.

Ways to increase low EF

Chronic heart failure is the main cause of impaired systolic (contractile) myocardial function, and therefore a decrease in ejection fraction. The development of CHF is promoted by:

1. Cardiac ischemia is a reduced amount of blood in the coronary vessels that supply the heart with oxygen.
2. Myocardial infarction, its large focality and transmurality. The end result is the replacement of healthy heart cells with scars that are unable to contract.
3. Diseases caused by irregular heart rhythm due to improper contraction.
4. Cardiomyopathy is stretching or enlargement of the heart muscle. Develops as a result hormonal imbalances, hypertension, heart disease.

Poor health, shortness of breath, swelling of the extremities indicate a low ejection fraction. How to increase the volume of fraction emission? Today, in modern medicine, therapy is in first place among the ways to increase EF. Patients are often observed on an outpatient basis, where the state of the heart, cardiovascular system and drug treatment are examined.

The doctor often prescribes diuretics that can reduce the amount of blood that circulates in the system, and ultimately the load on the heart. As well as glycosides, ACE inhibitors or beta-blockers, which reduce the heart’s need for oxygen, increase performance and reduce the energy requirement of the heart muscle.

In extreme cases, due to the danger of death, such as heart or valve defects, surgery is performed. In all other cases, therapy is indicated. Operations have been developed to restore blood flow in the coronary vessels in case of coronary heart disease and valve defects. During the operation, the valves are resected and prosthetics are performed. Thus, normalization of the rhythm is achieved, arrhythmia and fibrillation disappear.

Cardiovascular surgery requires the professionalism and experience of surgeons, so operations are performed in cardiology centers.

Prevention of low EF

If the patient does not have a predisposition to heart disease, then the value of the left ventricular ejection fraction can be successfully maintained within the normal range.

To prevent normal ejection fraction, doctors recommend:

1. Sports (aerobics), light exercise.
2. Do not carry heavy objects, go to the gym.
3. Quitting alcohol and smoking.
4. Healthy lifestyle.
5. Eating foods rich in iron.
6. Reduce salt intake.
7. Drink 1.5–2 liters of water per day.
8. Diet.

According to statistics from the 20th century, heart disease mainly affected people in old age. In the 21st century, these pathologies have become significantly younger. The risk group includes residents of megacities who live in conditions with high content car exhaust and low oxygen.

What is cardiac ejection fraction?

Today, due to poor ecology, many people have unstable health. This applies to all organs and systems in human body. Therefore, modern medicine has expanded its methods for studying pathological processes. Many patients wonder what cardiac ejection fraction (EF) is. The answer is simple, this condition is the most accurate indicator that can determine the level of performance of the human cardiac system. More precisely, the strength of the muscle at the moment of impact of the organ.

Definition

The cardiac ejection fraction can be defined as the percentage of the amount of blood that passes through the vessels during the systolic state of the ventricles.

For example, at 100 ml, 65 ml of blood enters the vascular system, respectively, the cardiac output of the heart fraction is 65%. Any deviations in one direction or another are an indicator of the presence of heart disease, requiring immediate treatment.

Healthy heart and heart failure

In most cases, measurements are taken from the left ventricle because blood flows from it into the systemic circulation. When there is a decrease in the amount of distilled contents, this is usually a consequence of heart failure.

Diagnostics such as left ventricular ejection fraction are prescribed to patients who have:

• Intense chest pain.
• Systematic failures in the functioning of the organ.
• Shortness of breath and cardiac tachycardia.
• Frequent fainting and dizziness.
• Weakness and fatigue.
• Decreased performance.

In most cases, during the examination, an ultrasound (ultrasound) of the heart and a cardiogram are prescribed. These studies provide output levels in the left and right side of the heart. Such diagnostics are quite informative and accessible to all patients.

Reasons

In fact, the causes of low cardiac ejection fraction are malfunctions of the organ. Heart failure is considered a condition that occurs as a result of long-term disruption of the system. Inflammatory diseases and malfunctions can lead to this pathology immune system, genetic and metabolic predisposition, pregnancy and much more.

Often the cause of heart failure is the presence of organ ischemia, a previous heart attack, hypertensive crisis, combination of hypertension and ischemic heart disease, valvular malformations.

Symptoms

Most often, symptoms of a reduced ejection fraction of the heart manifest themselves in a malfunction of the organ. To clarify the diagnosis, you need to undergo detailed examination and undergo a lot of tests.

If necessary, the doctor prescribes a number of pharmacological drugs that can cause increased heart function. This applies to any patient age category from infants to elderly patients.

Frequent shortness of breath and pain in the heart - cause cardiac ejection fraction disorders

Treatment

The most popular treatments for low cardiac ejection fraction are the use of medications. In cases where the main cause of this pathological process is heart failure, treatment is selected for the patient taking into account the age and characteristics of the body.

Dietary restrictions are almost always recommended, as well as a reduction in fluid intake. You need to drink no more than 2 liters per day, and then only clean, non-carbonated water. It is worth noting that for the entire period of treatment it is necessary to almost completely avoid eating salt. A number of diuretics, ACE inhibitors, digoxin and beta-blockers are prescribed.

All of the above agents significantly reduce the volume of circulating blood masses, which accordingly reduces the level of functioning of the organ. A number of other drugs can reduce the body's need for oxygen, while at the same time making its functionality more effective and at the same time less expensive. In some advanced cases used surgery, aimed at restoring blood flow in all coronary vessels. A similar method is used for ischemic disease.

In cases of severe defects and pathological processes, only surgery in combination with drug therapy is used as treatment. If necessary, artificial valves are installed that can prevent cardiac arrhythmia and many other cardiac failures, including fibrillation. Instrumental methods are used as a last resort, when drug therapy is unable to eliminate certain problems in the functioning of the cardiac system.

Norm

To determine natural norm For cardiac ejection fraction, a special Simpson or Teicholz table is used. It is worth noting that only after full examination The doctor can establish an accurate diagnosis and accordingly prescribe the most adequate treatment.

The presence of any pathological processes in the cardiac system is due to a regular lack of oxygen (oxygen starvation) and nutrients. In such cases, the heart muscles need support.

As a rule, all data is calculated using special equipment that can detect the presence of deviations. Most modern specialists, when using ultrasound diagnostics, prefer the Simpson method, which gives the most accurate results. The Teicholz formula is used less frequently. The choice in favor of one or another diagnostic method is made by the attending physician based on the test results and the patient’s health status. The ejection fraction of the heart must be normal at any age, otherwise failures can be considered a pathology.

The exact result of both methods is considered to be in the range of 50-60%. A slight difference between them is allowed, but not more than 10%. Ideally, the normal heart fraction in adults is exactly this percentage level. Both methods are considered highly informative. As a rule, according to the Simpson table, the outlier is 45%, and according to Teicholz - 55%. When the values ​​decrease to 35-40%, this is evidence of an advanced degree of heart failure, which can be fatal.

Normally, the heart should push out at least 50% of the blood it pumps. When this level decreases, heart failure occurs; in most cases it is progressive, which affects the development of pathological processes in many internal organs and systems.

The normal ejection fraction in children varies from 55 to 70%. If its level is below 40-55%, then this already indicates a malfunction of the heart. To prevent such deviations it is necessary to carry out preventive examination at the cardiologist.

Left ventricular ejection fraction of the heart: norms, reasons for low and high, how to increase

What is ejection fraction and why does it need to be assessed?

Cardiac ejection fraction (EF) is an indicator that reflects the volume of blood ejected by the left ventricle (LV) at the time of its contraction (systole) into the lumen of the aorta. EF is calculated based on the ratio of the volume of blood ejected into the aorta to the volume of blood present in the left ventricle at the moment of its relaxation (diastole). That is, when the ventricle is relaxed, it contains blood from the left atrium (end-diastolic volume - EDV), and then, contracting, it pushes part of the blood into the lumen of the aorta. This part of the blood is the ejection fraction, expressed as a percentage.

The ejection fraction of blood is a value that is technically easy to calculate, and which has a fairly high information content regarding myocardial contractility. The need to prescribe cardiac medications largely depends on this value, and also determines the prognosis for patients with cardiovascular failure.

The closer to normal values ​​a patient’s LV ejection fraction is, the better his heart contracts and the more favorable the prognosis for life and health. If the ejection fraction is much lower than normal, it means that the heart cannot contract normally and supply blood to the entire body, and in this case, the heart muscle should be supported with the help of medications.

How is ejection fraction calculated?

This indicator can be calculated using the Teicholtz or Simpson formula. The calculation is carried out using a program that automatically calculates the result depending on the final systolic and diastolic volume of the left ventricle, as well as its size.

The calculation using the Simpson method is considered more successful, since according to Teicholz, small areas of the myocardium with impaired local contractility may not be included in the research slice during two-dimensional Echo-CG, while with the Simpson method, larger areas of the myocardium fall into the circle slice.

Despite the fact that the Teicholz method is used on outdated equipment, modern ultrasound diagnostic rooms prefer to evaluate the ejection fraction using the Simpson method. The results obtained, by the way, may differ - depending on the method, by values ​​within 10%.

Normal EF values

The normal value of ejection fraction differs among different people, and also depends on the equipment on which the study is carried out, and on the method by which the fraction is calculated.

The average values ​​are approximately 50-60%, the lower limit of normal according to the Simpson formula is at least 45%, according to the Teicholz formula - at least 55%. This percentage means that exactly this amount of blood per heartbeat needs to be pushed by the heart into the lumen of the aorta to ensure adequate delivery of oxygen to the internal organs.

35-40% speak of advanced heart failure; even lower values ​​are fraught with fleeting consequences.

In children in the neonatal period, EF is at least 60%, mostly 60-80%, gradually reaching normal levels as they grow.

Of the deviations from the norm, more often than increased fraction emission, there is a decrease in its value due to various diseases.

If the indicator is reduced, it means that the heart muscle cannot contract sufficiently, as a result of which the volume of expelled blood decreases, and the internal organs, and, first of all, the brain, receive less oxygen.

Sometimes in the conclusion of echocardioscopy you can see that the EF value is higher than the average indicators (60% or more). As a rule, in such cases the figure is no more than 80%, since the larger volume of blood in the left ventricle due to physiological characteristics will not be able to expel into the aorta.

As a rule, high EF is observed in healthy individuals in the absence of other cardiac pathology, as well as in athletes with trained cardiac muscle, when the heart contracts with greater force with each beat than in an ordinary person and expels a larger percentage of the blood contained in it into the aorta.

In addition, if the patient has LV myocardial hypertrophy as a manifestation of hypertrophic cardiomyopathy or arterial hypertension, an increased EF may indicate that the heart muscle can still compensate for the incipient heart failure and strives to expel as much blood as possible into the aorta. As heart failure progresses, EF gradually decreases, so for patients with clinically manifested CHF it is very important to perform echocardioscopy over time so as not to miss a decrease in EF.

Causes of reduced cardiac ejection fraction

The main cause of impaired systolic (contractile) myocardial function is the development of chronic heart failure (CHF). In turn, CHF occurs and progresses due to diseases such as:

• Coronary heart disease - decreased blood flow through coronary arteries, supplying oxygen to the heart muscle itself,
• Previous myocardial infarctions, especially large-focal and transmural (extensive), as well as repeated ones, resulting in normal muscle cells hearts after a heart attack are replaced by scar tissue that does not have the ability to contract - post-infarction cardiosclerosis is formed (in the description of the ECG can be seen as the abbreviation PICS),

Decreased EF due to myocardial infarction (b). Affected areas of the heart muscle cannot contract

The most common cause of decreased cardiac output is acute or previous myocardial infarction, accompanied by a decrease in global or local contractility of the left ventricular myocardium.

Symptoms of reduced ejection fraction

All symptoms that may suggest a decrease in the contractile function of the heart are caused by CHF. Therefore, the symptoms of this disease come first.

However, according to the observations of practicing ultrasound diagnostic doctors, the following is often observed - in patients with severe signs of CHF, the ejection fraction remains within the normal range, while in people with no obvious symptoms, the ejection fraction is significantly reduced. Therefore, despite the absence of symptoms, patients with cardiac pathology must undergo echocardioscopy at least once a year.

So, symptoms that suggest a violation of myocardial contractility include:

1. Attacks of shortness of breath at rest or during physical activity, as well as when lying down, especially at night,
2. The load that provokes the occurrence of shortness of breath attacks can be different - from significant, for example, walking long distances (we are sick), to minimal household activity, when it is difficult for the patient to perform the simplest manipulations - cooking, tying shoelaces, walking to the next room, etc. d,
3. Weakness, fatigue, dizziness, sometimes loss of consciousness - all this indicates that the skeletal muscles and brain receive little blood,
4. Swelling on the face, legs and feet, and in severe cases - in internal cavities body and throughout the body (anasarca) due to impaired blood circulation through the vessels of the subcutaneous fatty tissue, in which fluid retention occurs,
5. Pain in right half abdomen, an increase in abdominal volume due to fluid retention in the abdominal cavity (ascites) - arise due to venous stagnation in the hepatic vessels, and long-term stagnation can lead to cardiac cirrhosis of the liver.

In the absence of proper treatment for systolic myocardial dysfunction, such symptoms progress, increase and become increasingly difficult for the patient to tolerate, therefore, if even one of them occurs, you should consult a general practitioner or cardiologist.

When is treatment for reduced ejection fraction required?

Of course, no doctor will suggest that you treat a low reading obtained from a heart ultrasound. First, the doctor must identify the cause of the reduced EF, and then prescribe treatment for the causative disease. Depending on it, treatment may vary, for example, taking nitroglycerin drugs for coronary artery disease, surgical correction of heart defects, antihypertensive drugs for hypertension, etc. It is important for the patient to understand that if there is a decrease in the ejection fraction, it means that heart failure is really developing and it is necessary to follow the doctor’s recommendations for a long time and scrupulously.

How to increase reduced ejection fraction?

In addition to drugs that affect the causative disease, the patient is prescribed drugs that can improve myocardial contractility. These include cardiac glycosides (digoxin, strophanthin, corglycone). However, they are prescribed strictly by the attending physician and their independent uncontrolled use is unacceptable, since poisoning may occur - glycoside intoxication.

To prevent volume overload of the heart, that is, excess fluid, it is recommended to follow a diet limiting table salt to 1.5 grams per day and limiting fluid intake to 1.5 liters per day. Diuretic drugs (diuretics) are also successfully used - diacarb, diuver, veroshpiron, indapamide, torasemide, etc.

To protect the heart and blood vessels from the inside, drugs with so-called organoprotective properties - ACE inhibitors - are used. These include enalapril (Enap, Enam), perindopril (Prestarium, Prestans), lisinopril, captopril (Capoten). Also among drugs with similar properties, ARA II inhibitors are widely used - losartan (Lorista, Lozap), valsartan (Valz), etc.

The treatment regimen is always selected individually, but the patient must be prepared for the fact that the ejection fraction does not return to normal immediately, and symptoms may persist for some time after the start of therapy.

In some cases, the only method to cure the disease that caused the development of CHF is surgery. Surgeries for valve replacement, installation of stents or shunts on coronary vessels, installation of a pacemaker, etc. may be necessary.

However, in cases of severe heart failure (functional class III-IV) with extremely low ejection fraction, surgery may be contraindicated. For example, a contraindication to mitral valve replacement is a decrease in EF of less than 20%, and to implantation of a pacemaker - less than 35%. However, contraindications to operations are identified during an in-person examination by a cardiac surgeon.

Prevention

Preventive focus on prevention cardiovascular diseases, leading to a low ejection fraction, remains especially relevant in today’s environmentally unfavorable environment, in the era of a sedentary lifestyle in front of computers and eating low-health foods.

Even based on this, we can say that frequent recreation outside the city in the fresh air, healthy eating, adequate physical activity(walking, easy running, exercises, gymnastics), giving up bad habits - all this is the key to long-term and proper functioning of the cardiovascular system with normal contractility and fitness of the heart muscle.