Which echo finding confirms HFrEF?

• A. Normal LV ejection fraction.
• B. Reduced LV ejection fraction (<40%) with or without LV dilation.
• C. LV hypertrophy with preserved EF.
• D. Dilated RV with preserved LV EF.

Answer: (B)

Echocardiography defines heart failure with reduced ejection fraction by a diminished left ventricular systolic function. In this scenario, the ejection fraction is below about 40%, sometimes with left ventricular dilation due to remodeling. This reduced EF reflects impaired pumping ability of the left ventricle, which is the hallmark of systolic failure.

Normal ejection fraction on echo would argue against HFrEF, since the heart’s pumping function is preserved. LV hypertrophy with preserved EF points to heart failure with preserved ejection fraction, where diastolic dysfunction is the main issue rather than systolic failure. Dilated right ventricle with preserved LV EF doesn’t demonstrate LV systolic impairment, so it doesn’t define HFrEF.

So the echo finding that confirms HFrEF is a reduced LV ejection fraction, typically less than 40%, with or without LV dilation.