Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete?

Michael R. Bristow, David P. Kao, Khadijah K. Breathett, Natasha L. Altman, John Gorcsan, Edward A. Gill, Brian D Lowes, Edward M. Gilbert, Robert A. Quaife, Douglas L. Mann

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.

Original languageEnglish (US)
Pages (from-to)772-781
Number of pages10
JournalJACC: Heart Failure
Volume5
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Stroke Volume
Heart Failure
Phenotype
Ventricular Remodeling
Left Ventricular Function
Biomarkers
Hemodynamics
History
Technology
Therapeutics

Keywords

  • ejection fraction
  • gene expression
  • heart failure
  • left ventricular function
  • left ventricular structure
  • phenotyping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bristow, M. R., Kao, D. P., Breathett, K. K., Altman, N. L., Gorcsan, J., Gill, E. A., ... Mann, D. L. (2017). Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete? JACC: Heart Failure, 5(11), 772-781. https://doi.org/10.1016/j.jchf.2017.09.009

Structural and Functional Phenotyping of the Failing Heart : Is the Left Ventricular Ejection Fraction Obsolete? / Bristow, Michael R.; Kao, David P.; Breathett, Khadijah K.; Altman, Natasha L.; Gorcsan, John; Gill, Edward A.; Lowes, Brian D; Gilbert, Edward M.; Quaife, Robert A.; Mann, Douglas L.

In: JACC: Heart Failure, Vol. 5, No. 11, 01.11.2017, p. 772-781.

Research output: Contribution to journalReview article

Bristow, MR, Kao, DP, Breathett, KK, Altman, NL, Gorcsan, J, Gill, EA, Lowes, BD, Gilbert, EM, Quaife, RA & Mann, DL 2017, 'Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete?', JACC: Heart Failure, vol. 5, no. 11, pp. 772-781. https://doi.org/10.1016/j.jchf.2017.09.009
Bristow, Michael R. ; Kao, David P. ; Breathett, Khadijah K. ; Altman, Natasha L. ; Gorcsan, John ; Gill, Edward A. ; Lowes, Brian D ; Gilbert, Edward M. ; Quaife, Robert A. ; Mann, Douglas L. / Structural and Functional Phenotyping of the Failing Heart : Is the Left Ventricular Ejection Fraction Obsolete?. In: JACC: Heart Failure. 2017 ; Vol. 5, No. 11. pp. 772-781.
@article{e638b679d1824c0aa0e06b276db18364,
title = "Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete?",
abstract = "Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.",
keywords = "ejection fraction, gene expression, heart failure, left ventricular function, left ventricular structure, phenotyping",
author = "Bristow, {Michael R.} and Kao, {David P.} and Breathett, {Khadijah K.} and Altman, {Natasha L.} and John Gorcsan and Gill, {Edward A.} and Lowes, {Brian D} and Gilbert, {Edward M.} and Quaife, {Robert A.} and Mann, {Douglas L.}",
year = "2017",
month = "11",
day = "1",
doi = "10.1016/j.jchf.2017.09.009",
language = "English (US)",
volume = "5",
pages = "772--781",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "11",

}

TY - JOUR

T1 - Structural and Functional Phenotyping of the Failing Heart

T2 - Is the Left Ventricular Ejection Fraction Obsolete?

AU - Bristow, Michael R.

AU - Kao, David P.

AU - Breathett, Khadijah K.

AU - Altman, Natasha L.

AU - Gorcsan, John

AU - Gill, Edward A.

AU - Lowes, Brian D

AU - Gilbert, Edward M.

AU - Quaife, Robert A.

AU - Mann, Douglas L.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.

AB - Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.

KW - ejection fraction

KW - gene expression

KW - heart failure

KW - left ventricular function

KW - left ventricular structure

KW - phenotyping

UR - http://www.scopus.com/inward/record.url?scp=85032470743&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032470743&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2017.09.009

DO - 10.1016/j.jchf.2017.09.009

M3 - Review article

C2 - 29096787

AN - SCOPUS:85032470743

VL - 5

SP - 772

EP - 781

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

IS - 11

ER -