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First phase ejection fraction in aortic stenosis: A useful new measure of early left ventricular systolic dysfunction

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)932-935
Number of pages4
JournalJournal of Clinical Ultrasound
Issue number9
Early online date10 Sep 2021
Accepted/In press2021
E-pub ahead of print10 Sep 2021
Published1 Nov 2021

Bibliographical note

Publisher Copyright: © 2021 The Authors. Journal of Clinical Ultrasound published by Wiley Periodicals LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


In aortic stenosis (AS), a left ventricular (LV) ejection fraction (EF) <50% or symptoms are class I indications for aortic valve intervention. However, an EF <50% may be too conservative since subendocardial fibrosis may already have developed. An earlier marker of LV systolic dysfunction is therefore needed and first phase EF (EF1) is a promising new candidate. It is the EF measured over early systole to the point of maximum transaortic blood flow. It may be low in the presence of preserved total LV EF since the heart may compensate by recruiting myosin motors in later systole. The EF1 is inversely related to the grade of AS and directly related to markers of subendocardial fibrosis like late gadolinium enhancement on cardiac magnetic resonance scanning. A reduced EF1 (<25%) predicts adverse clinical events better that total EF and global longitudinal strain. We suggest that it is worth exploring as an indication for surgery in patients with asymptomatic severe AS.

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