HFrEF Learning Center

Reduced cardiac contractility is central to heart failure with reduced ejection fraction (HFrEF) manifestation and progression


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HFrEF is a progressive disorder that occurs when the heart is unable to maintain sufficient cardiac output to accommodate the body’s metabolic requirements and venous return.1

Surrogate Measures of Contractility

Because it is difficult to measure contractility directly, there are three main surrogate measures: dP/dt, systolic ejection time (SET), and left ventricular ejection fraction (LVEF).7,10-13,15

Lower values of dP/dtmax, SET, and LVEF are associated with increases in morbidity and mortality in patients with HFrEF.11,13-15

Please choose from the dropdown options to learn more about these surrogate measures.

The maximum rate of rising LV pressure during the isovolumic contraction phase of LV systole (dP/dtmax) is a surrogate measure of LV contractility.10

SET is defined by the opening and closing of the aortic valve.11,12

In HFrEF, SET is shortened as the rate of LV pressure generation is diminished, resulting in prolongation of the pre-ejection, isovolumic contraction period.11,17,19

The degree of LV shortening correlates with LV dysfunction and is associated with increased morbidity and mortality.11,19

LVEF is a classic surrogate measure of contractility, measurable by echocardiography or radionuclide ventriculography. These techniques also measure how much ventricular dilation has occurred.1,13,20

To maintain cardiac output, the failing heart dilates to increase stroke volume.20

Along with LV dilation in the failing heart, LV filling pressure also rises.1

Decreased contractility, poor cardiac output, and elevated LV filling pressures result in the signs and symptoms of HF.21,22

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