Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology



+44 (0)20 7351 8810d.pennell




CMR UnitRoyal BromptonRoyal Brompton Campus






BibTex format

author = {Halliday, B and Senior, R and Pennell, D},
journal = {European Heart Journal},
title = {Assessing left ventricular systolic function – from ejection fraction to strain analysis},
url = {},
year = {2020}

RIS format (EndNote, RefMan)

AB - The measurement of left ventricular ejection fraction (LVEF) is a ubiquitous component of imaging studies used to evaluate patients with cardiac conditions and acts as an arbiter for many management decisions. This follows early trials investigating heart failure therapies which used a binary LVEF cut-off to select patients with the worst prognosis, who may gain the most benefit. Forty years on, the cardiac disease landscape has changed. LVEF is now a poor indicator of prognosis for many heart failure patients; specifically, for the half of patients with heart failure and truly preserved ejection fraction (HF-PEF). It is also recognised that LVEF may remain normal amongst patients with valvular heart disease who have significant myocardial dysfunction. This emphasises the importance of the interaction between LVEF and left ventricular geometry. Guidelines based on LVEF may therefore miss a proportion of patients who would benefit from early intervention to prevent further myocardial decompensation and future adverse outcomes. The assessment of myocardial strain, or intrinsic deformation, holds promise to improve these issues. The measurement of global longitudinal strain (GLS) has consistently been shown to improve the risk stratification of patients with heart failure and identify patients with valvular heart disease who have myocardial decompensation despite preserved LVEF and an increased risk of adverse outcomes. To complete the integration of GLS into routine clinical practice, further studies are required to confirm that such approaches improve therapy selection and accordingly, the outcome for patients.
AU - Halliday,B
AU - Senior,R
AU - Pennell,D
PY - 2020///
SN - 0195-668X
TI - Assessing left ventricular systolic function – from ejection fraction to strain analysis
T2 - European Heart Journal
UR -
ER -