Guideline Recommended Practice

Conducting LV EF Assessment
Two-dimensional echocardiogram coupled with Doppler flow studies should be performed during initial evaluation of patients presenting with HF to assess LVEF, left ventricular size, wall thickness, wall motion, and valve function. Radionuclide ventriculography can be performed to assess LVEF and volumes.

Four fundamental questions must be addressed:

  1. Is the LV ejection fraction (EF) preserved or reduced?
  2. Is the structure of the LV normal or abnormal?
  3. Are there other structural abnormalities such as valvular, pericardial, or right ventricular abnormalities that could account for the clinical presentation?
  4. Is there an identifiable cause or suggestion for the cause of heart failure (i.e. ischemia, restrictive, infiltrative, etc.)?

This information should be quantified with:

  • Numerical estimate of EF
  • Measurement of ventricular dimensions and/or volumes
  • Measurement of wall thickness
  • Evaluation of chamber geometry and regional wall motion

Performance Measure Reporting

What's Being Measured
Percentage of your patients, ≥ 18 years of age with a diagnosis of heart failure, that has documentation within the last 12 months of an LVEF assessment.

How to Satisfy this Measure
Document at least once within a 12 month period the LVEF assessment of all patients ≥ 18 years with a diagnosis of HF. Documentation in a progress note can be the results of a recent or prior (any time in the past) LVEF assessment. Documentation may be quantitative (ejection fraction value) or qualitative (eg, "moderate dysfunction" or visually estimated ejection fraction).

Qualitative results should correspond to the numeric equivalents as follows:

  • Hyperdynamic = LVEF greater than 70%
  • Normal = LVEF 50% to 70% (midpoint 60%)
  • Mild dysfunction = LVEF 40% to 49% (midpoint 45%)
  • Moderate dysfunction = LVEF 30% to 39% (midpoint 35%)
  • Severe dysfunction = LVEF less than 30%