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Severely reduced left ventricular ejection fraction

MedGen UID:
868396
Concept ID:
C4022790
Finding
Synonym: Severely reduced ejection fraction
 
HPO: HP:0012666

Definition

A large reduction in the fraction of blood pumped from the left ventricle with each cardiac cycle. The normal range in adults is at over 50 percent, and a severe reduction is defined as less than 30 percent. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVSeverely reduced left ventricular ejection fraction

Conditions with this feature

Pseudo-Hurler polydystrophy
MedGen UID:
10988
Concept ID:
C0033788
Disease or Syndrome
GNPTAB-related disorders comprise the phenotypes mucolipidosis II (ML II) and mucolipidosis IIIa/ß (ML IIIa/ß), and phenotypes intermediate between ML II and ML IIIa/ß. ML II is evident at birth and slowly progressive; death most often occurs in early childhood. Orthopedic abnormalities present at birth may include thoracic deformity, kyphosis, clubfeet, deformed long bones, and/or dislocation of the hip(s). Growth often ceases in the second year of life; contractures develop in all large joints. The skin is thickened, facial features are coarse, and gingiva are hypertrophic. All children have cardiac involvement, most commonly thickening and insufficiency of the mitral valve and, less frequently, the aortic valve. Progressive mucosal thickening narrows the airways, and gradual stiffening of the thoracic cage contributes to respiratory insufficiency, the most common cause of death. ML IIIa/ß becomes evident at about age three years with slow growth rate and short stature; joint stiffness and pain initially in the shoulders, hips, and fingers; gradual mild coarsening of facial features; and normal to mildly impaired cognitive development. Pain from osteoporosis becomes more severe during adolescence. Cardiorespiratory complications (restrictive lung disease, thickening and insufficiency of the mitral and aortic valves, left and/or right ventricular hypertrophy) are common causes of death, typically in early to middle adulthood. Phenotypes intermediate between ML II and ML IIIa/ß are characterized by physical growth in infancy that resembles that of ML II and neuromotor and speech development that resemble that of ML IIIa/ß.
Danon disease
MedGen UID:
209235
Concept ID:
C0878677
Disease or Syndrome
Danon disease is a multisystem condition with predominant involvement of the heart, skeletal muscles, and retina, with overlying cognitive dysfunction. Males are typically more severely affected than females. Males usually present with childhood onset concentric hypertrophic cardiomyopathy that is progressive and often requires heart transplantation. Rarely, hypertrophic cardiomyopathy can evolve to resemble dilated cardiomyopathy. Most affected males also have cardiac conduction abnormalities. Skeletal muscle weakness may lead to delayed acquisition of motor milestones. Learning disability and intellectual disability, most often in the mild range, are common. Additionally, affected males can develop retinopathy with subsequent visual impairment. The clinical features in females are broader and more variable. Females are more likely to have dilated cardiomyopathy, with a smaller proportion requiring heart transplantation compared to affected males. Cardiac conduction abnormalities, skeletal muscle weakness, mild cognitive impairment, and pigmentary retinopathy are variably seen in affected females.
Early-onset myopathy with fatal cardiomyopathy
MedGen UID:
435983
Concept ID:
C2673677
Disease or Syndrome
Salih myopathy is characterized by muscle weakness (manifest during the neonatal period or in early infancy) and delayed motor development; children acquire independent walking between ages 20 months and four years. In the first decade of life, global motor performance is stable or tends to improve. Moderate joint and neck contractures and spinal rigidity may manifest in the first decade but become more obvious in the second decade. Scoliosis develops after age 11 years. Cardiac dysfunction manifests between ages five and 16 years, progresses rapidly, and leads to death between ages eight and 20 years, usually from heart rhythm disturbances.
Dilated cardiomyopathy 1FF
MedGen UID:
412876
Concept ID:
C2750091
Disease or Syndrome
A dilated cardiomyopathy that has material basis in mutation in the TNNI3 gene on chromosome 19q13.42.
Hypertrophic cardiomyopathy 14
MedGen UID:
442484
Concept ID:
C2750467
Disease or Syndrome
An autosomal dominant subtype of familial hypertrophic cardiomyopathy caused by mutation(s) in the MYH6 gene, encoding myosin-6.
Dilated cardiomyopathy 1BB
MedGen UID:
414552
Concept ID:
C2752072
Disease or Syndrome
Dilated cardiomyopathy-1BB (CMD1BB) is a life-threatening, intractable disease characterized by ventricular dilation and thinning (Shiba et al., 2021). For a phenotypic description and a discussion of genetic heterogeneity of dilated cardiomyopathy, see CMD1A (115200).
Dilated cardiomyopathy 1U
MedGen UID:
463620
Concept ID:
C3160720
Disease or Syndrome
Any familial isolated dilated cardiomyopathy in which the cause of the disease is a mutation in the PSEN1 gene.
Cardiomyopathy, dilated, 2F
MedGen UID:
1802616
Concept ID:
C5676917
Disease or Syndrome
Dilated cardiomyopathy-2F (CMD2F) is an autosomal recessive early-onset cardiomyopathy associated with refractory ventricular arrhythmias and severe heart failure requiring placement of a left ventricular assist device (Hakui et al., 2022). For a general phenotypic description and discussion of genetic heterogeneity of dilated cardiomyopathy, see 115200.
Cardiomyopathy, dilated, 2G
MedGen UID:
1801983
Concept ID:
C5676995
Disease or Syndrome
Dilated cardiomyopathy-2G (CMD2G) is characterized by early-onset severe dilated cardiomyopathy that progresses rapidly to heart failure in the neonatal period without evidence of intervening hypertrophy. Cardiac tissue exhibits markedly shortened thin filaments, disorganized myofibrils, and reduced contractile force generation, resulting in the severe ventricular dysfunction observed. There is no evidence of skeletal muscle hypertrophy (Ahrens-Nicklas et al., 2019). For a general phenotypic description and a discussion of genetic heterogeneity of dilated cardiomyopathy, see 115200.
Cardiomyopathy, dilated, 2I
MedGen UID:
1841321
Concept ID:
C5830685
Disease or Syndrome
Dilated cardiomyopathy-2I (CMD2I) is characterized by early-onset severe congestive heart failure. Some patients experience supraventricular tachycardia. Structural heart defects and nemaline bodies in cardiac and skeletal muscle have been observed (Aspit et al., 2019; Cheema et al., 2020; Gurunathan et al., 2022). For a general phenotypic description and discussion of genetic heterogeneity of dilated cardiomyopathy, see 115200.
Long-Olsen-Distelmaier syndrome
MedGen UID:
1847052
Concept ID:
C5882721
Disease or Syndrome
Long-Olsen-Distelmaier syndrome (LNGODS) is a severe, early-onset disease with multiple system involvement and lethal dilated cardiomyopathy (DCM) as a core clinical feature (summary by Reijnders et al., 2023).
Cardiomyopathy, dilated, 2j
MedGen UID:
1846005
Concept ID:
C5882725
Disease or Syndrome
Dilated cardiomyopathy-2J (CMD2J) is characterized by onset of heart failure within the first year of life, with severely reduced left ventricular ejection fractions (Ruijmbeek et al., 2023). For a general phenotypic description and discussion of genetic heterogeneity of dilated cardiomyopathy, see 115200.
Combined oxidative phosphorylation deficiency 59
MedGen UID:
1845781
Concept ID:
C5882730
Disease or Syndrome
Combined oxidative phosphorylation deficiency-59 (COXPD59) may present as a lethal infantile form of Leigh syndrome (see 256000) or as a milder disorder with hypertrophic cardiomyopathy, lactic acidosis, attention deficit-hyperactivity disorder (ADHD) and survival into adulthood (summary by Amarasekera et al., 2023). For a discussion of genetic heterogeneity of combined oxidative phosphorylation deficiency, see COXPD1 (609060).

Professional guidelines

PubMed

Frischknecht L, Schaab J, Schmauch E, Yalamanoglu A, Arnold DD, Schwaiger J, Gruner C, Buechel RR, Franzen DP, Kolios AGA, Nilsson J
Front Immunol 2023;14:1286684. Epub 2023 Nov 24 doi: 10.3389/fimmu.2023.1286684. PMID: 38077350Free PMC Article
Artico J, Ceolin R, Franco S, Paldino A, Biondi F, Barbati G, Gentile P, Cannatà A, Zecchin M, Carriere C, Merlo M, Sinagra G
Int J Cardiol 2019 Oct 15;293:119-124. Epub 2019 Jul 4 doi: 10.1016/j.ijcard.2019.06.072. PMID: 31303396

Recent clinical studies

Etiology

Litwin SE, Komtebedde J, Hu M, Burkhoff D, Hasenfuß G, Borlaug BA, Solomon SD, Zile MR, Mohan RC, Khawash R, Sverdlov AL, Fail P, Chung ES, Kaye DM, Blair J, Eicher JC, Hummel SL, Zirlik A, Westenfeld R, Hayward C, Gorter TM, Demers C, Shetty R, Lewis G, Starling RC, Patel S, Gupta DK, Morsli H, Penicka M, Cikes M, Gustafsson F, Silvestry FE, Rowin EJ, Cutlip DE, Leon MB, Kitzman DW, Kleber FX, Shah SJ; REDUCE LAP-HF Investigators and Research Staff
JACC Heart Fail 2023 Aug;11(8 Pt 2):1103-1117. Epub 2023 Mar 20 doi: 10.1016/j.jchf.2023.01.030. PMID: 36939661Free PMC Article
Romano KA, Nemet I, Prasad Saha P, Haghikia A, Li XS, Mohan ML, Lovano B, Castel L, Witkowski M, Buffa JA, Sun Y, Li L, Menge CM, Demuth I, König M, Steinhagen-Thiessen E, DiDonato JA, Deb A, Bäckhed F, Tang WHW, Naga Prasad SV, Landmesser U, Van Wagoner DR, Hazen SL
Circ Heart Fail 2023 Jan;16(1):e009972. Epub 2022 Dec 16 doi: 10.1161/CIRCHEARTFAILURE.122.009972. PMID: 36524472Free PMC Article
Omote K, Borlaug BA
Circ J 2023 Jul 25;87(8):1039-1046. Epub 2021 Oct 12 doi: 10.1253/circj.CJ-21-0795. PMID: 34645733
Murphy SP, Ibrahim NE, Januzzi JL Jr
JAMA 2020 Aug 4;324(5):488-504. doi: 10.1001/jama.2020.10262. PMID: 32749493
Sun LY, Gaudino M, Chen RJ, Bader Eddeen A, Ruel M
JAMA Cardiol 2020 Jun 1;5(6):631-641. doi: 10.1001/jamacardio.2020.0239. PMID: 32267465Free PMC Article

Diagnosis

Ioannou A, Massa P, Patel RK, Razvi Y, Porcari A, Rauf MU, Jiang A, Cabras G, Filisetti S, Bolhuis RE, Bandera F, Venneri L, Martinez-Naharro A, Law S, Kotecha T, Virsinskaite R, Knight DS, Emdin M, Petrie A, Lachmann H, Wechelakar A, Petrie M, Hughes A, Freemantle N, Hawkins PN, Whelan C, McMurray JJV, Gillmore JD, Fontana M
Eur Heart J 2023 Aug 14;44(31):2893-2907. doi: 10.1093/eurheartj/ehad347. PMID: 37216684Free PMC Article
Smiseth OA, Morris DA, Cardim N, Cikes M, Delgado V, Donal E, Flachskampf FA, Galderisi M, Gerber BL, Gimelli A, Klein AL, Knuuti J, Lancellotti P, Mascherbauer J, Milicic D, Seferovic P, Solomon S, Edvardsen T, Popescu BA; Reviewers: This document was reviewed by members of the 2018–2020 EACVI Scientific Documents Committee
Eur Heart J Cardiovasc Imaging 2022 Jan 24;23(2):e34-e61. doi: 10.1093/ehjci/jeab154. PMID: 34729586
Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, Albert NM, Duffy CI, Patterson JH, Thomas L, Williams FB, Hernandez AF, Fonarow GC
JAMA Cardiol 2021 May 1;6(5):522-531. doi: 10.1001/jamacardio.2021.0372. PMID: 33760037Free PMC Article
Murphy SP, Ibrahim NE, Januzzi JL Jr
JAMA 2020 Aug 4;324(5):488-504. doi: 10.1001/jama.2020.10262. PMID: 32749493
Castaño A, Narotsky DL, Hamid N, Khalique OK, Morgenstern R, DeLuca A, Rubin J, Chiuzan C, Nazif T, Vahl T, George I, Kodali S, Leon MB, Hahn R, Bokhari S, Maurer MS
Eur Heart J 2017 Oct 7;38(38):2879-2887. doi: 10.1093/eurheartj/ehx350. PMID: 29019612Free PMC Article

Therapy

Romano KA, Nemet I, Prasad Saha P, Haghikia A, Li XS, Mohan ML, Lovano B, Castel L, Witkowski M, Buffa JA, Sun Y, Li L, Menge CM, Demuth I, König M, Steinhagen-Thiessen E, DiDonato JA, Deb A, Bäckhed F, Tang WHW, Naga Prasad SV, Landmesser U, Van Wagoner DR, Hazen SL
Circ Heart Fail 2023 Jan;16(1):e009972. Epub 2022 Dec 16 doi: 10.1161/CIRCHEARTFAILURE.122.009972. PMID: 36524472Free PMC Article
Tomasoni D, Vishram-Nielsen JKK, Pagnesi M, Adamo M, Lombardi CM, Gustafsson F, Metra M
ESC Heart Fail 2022 Jun;9(3):1507-1523. Epub 2022 Mar 30 doi: 10.1002/ehf2.13859. PMID: 35352499Free PMC Article
Al Saadi T, Assaf Y, Farwati M, Turkmani K, Al-Mouakeh A, Shebli B, Khoja M, Essali A, Madmani ME
Cochrane Database Syst Rev 2021 Feb 3;(2)(2):CD008684. doi: 10.1002/14651858.CD008684.pub3. PMID: 35608922Free PMC Article
Murphy SP, Ibrahim NE, Januzzi JL Jr
JAMA 2020 Aug 4;324(5):488-504. doi: 10.1001/jama.2020.10262. PMID: 32749493
Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, Lefèvre T, Piot C, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Leclercq F, Saint Etienne C, Teiger E, Leroux L, Karam N, Michel N, Gilard M, Donal E, Trochu JN, Cormier B, Armoiry X, Boutitie F, Maucort-Boulch D, Barnel C, Samson G, Guerin P, Vahanian A, Mewton N; MITRA-FR Investigators
N Engl J Med 2018 Dec 13;379(24):2297-2306. Epub 2018 Aug 27 doi: 10.1056/NEJMoa1805374. PMID: 30145927

Prognosis

Soares LR, Vilbert M, Rosa VDL, Oliveira JL, Deus MM, Freitas-Junior R
ESMO Open 2023 Aug;8(4):101613. Epub 2023 Jul 23 doi: 10.1016/j.esmoop.2023.101613. PMID: 37481956Free PMC Article
Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, Albert NM, Duffy CI, Patterson JH, Thomas L, Williams FB, Hernandez AF, Fonarow GC
JAMA Cardiol 2021 May 1;6(5):522-531. doi: 10.1001/jamacardio.2021.0372. PMID: 33760037Free PMC Article
Murphy SP, Ibrahim NE, Januzzi JL Jr
JAMA 2020 Aug 4;324(5):488-504. doi: 10.1001/jama.2020.10262. PMID: 32749493
Sun LY, Gaudino M, Chen RJ, Bader Eddeen A, Ruel M
JAMA Cardiol 2020 Jun 1;5(6):631-641. doi: 10.1001/jamacardio.2020.0239. PMID: 32267465Free PMC Article
Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, Parissis J, Laroche C, Piepoli MF, Fonseca C, Mebazaa A, Lund L, Ambrosio GA, Coats AJ, Ferrari R, Ruschitzka F, Maggioni AP, Filippatos G
Eur J Heart Fail 2017 Dec;19(12):1574-1585. Epub 2017 Apr 6 doi: 10.1002/ejhf.813. PMID: 28386917

Clinical prediction guides

Murphy SP, Ibrahim NE, Januzzi JL Jr
JAMA 2020 Aug 4;324(5):488-504. doi: 10.1001/jama.2020.10262. PMID: 32749493
Cautela J, Tartiere JM, Cohen-Solal A, Bellemain-Appaix A, Theron A, Tibi T, Januzzi JL Jr, Roubille F, Girerd N
Eur J Heart Fail 2020 Aug;22(8):1357-1365. Epub 2020 Apr 30 doi: 10.1002/ejhf.1835. PMID: 32353213Free PMC Article
Sun LY, Gaudino M, Chen RJ, Bader Eddeen A, Ruel M
JAMA Cardiol 2020 Jun 1;5(6):631-641. doi: 10.1001/jamacardio.2020.0239. PMID: 32267465Free PMC Article
Castaño A, Narotsky DL, Hamid N, Khalique OK, Morgenstern R, DeLuca A, Rubin J, Chiuzan C, Nazif T, Vahl T, George I, Kodali S, Leon MB, Hahn R, Bokhari S, Maurer MS
Eur Heart J 2017 Oct 7;38(38):2879-2887. doi: 10.1093/eurheartj/ehx350. PMID: 29019612Free PMC Article
Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, Parissis J, Laroche C, Piepoli MF, Fonseca C, Mebazaa A, Lund L, Ambrosio GA, Coats AJ, Ferrari R, Ruschitzka F, Maggioni AP, Filippatos G
Eur J Heart Fail 2017 Dec;19(12):1574-1585. Epub 2017 Apr 6 doi: 10.1002/ejhf.813. PMID: 28386917

Recent systematic reviews

Taha AM, Hendi NI, Elwekel AB, Atia A, Taha NA, Shrestha AB, Elbanna M
Clin Cardiol 2024 Jan;47(1):e24177. Epub 2023 Oct 25 doi: 10.1002/clc.24177. PMID: 37877802Free PMC Article
Padhani ZA, Gangwani MK, Sadaf A, Hasan B, Colan S, Alvi N, Das JK
Cochrane Database Syst Rev 2023 Nov 17;11(11):CD011626. doi: 10.1002/14651858.CD011626.pub3. PMID: 37975597Free PMC Article
Soares LR, Vilbert M, Rosa VDL, Oliveira JL, Deus MM, Freitas-Junior R
ESMO Open 2023 Aug;8(4):101613. Epub 2023 Jul 23 doi: 10.1016/j.esmoop.2023.101613. PMID: 37481956Free PMC Article
Aimo A, Merlo M, Porcari A, Georgiopoulos G, Pagura L, Vergaro G, Sinagra G, Emdin M, Rapezzi C
Eur J Heart Fail 2022 Dec;24(12):2342-2351. Epub 2022 May 16 doi: 10.1002/ejhf.2532. PMID: 35509173Free PMC Article
Al Saadi T, Assaf Y, Farwati M, Turkmani K, Al-Mouakeh A, Shebli B, Khoja M, Essali A, Madmani ME
Cochrane Database Syst Rev 2021 Feb 3;(2)(2):CD008684. doi: 10.1002/14651858.CD008684.pub3. PMID: 35608922Free PMC Article

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