La serendipia en torno la fracción de eyección: una revisión de la historia, la casualidad y la cuasi-funcionalidad de una métrica aplaudida

Translated title of the contribution: A critical analysis of ejection fraction

Peter L. M. Kerkhof, Rienzi Díaz-Navarro, G. UY R. HEYNDRICKX, Neal Handly

Research output: Contribution to journalArticleProfessional


Ejection fraction (EF) is defined by the ratio of end-systolic volume (ESV) and end-diastolic volume (EDV). The resulting fraction is a dimensionless number whose interpretation is ambiguous and most likely misleading. Despite this limitation, EF is widely accepted as a clinical marker of cardiac function. In this article we analyze the role of ESV, a fundamental variable of ventricular mechanics, compared with the popular EF. Common physiology-based mathematics can explain a simple association between EF and ESV. This concept is illustrated by a detailed analysis of the information obtained from angiocardiography, echocardiography and cardiac magnetic resonance studies. EF versus ESV produces a non-linear curve. For a small ESV, the EF approaches 100%, while for a large ESV, the EF gradually decreases toward zero. This elemental relationship is commonly observed in innervated natural hearts. Thus, the popularity of EF mostly derives from a fortuitous connection with the pivotal variable ESV. Alongside this finding, we unfold historical events that facilitated the emergence of EF as a result of serendipity. Our physiology-based approach denounces the circumstantial theories invoked to justify the importance of EF as an index of cardiac function, which are critically discussed. EF appears to be nothing more than a blessing in disguise. For this reason, we propose the ESV as a more logical metric for the analysis of ventricular function.
Translated title of the contributionA critical analysis of ejection fraction
Original languageSpanish
Pages (from-to)232-240
Number of pages9
JournalRevista Medica de Chile
Issue number2
Publication statusPublished - 1 Feb 2022


  • Heart Failure
  • Heart Ventricles
  • Physiology
  • Ventricular Dysfunction
  • Ventricular Function

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