Beyond Ejection Fraction: Integrating Myocardial Strain and Cardiac Magnetic Resonance into the Contemporary Assessment of Left Ventricular Function

The assessment of left ventricular function is undergoing a profound transformation. For decades, left ventricular ejection fraction (LVEF) has occupied a central role in clinical practice, guiding diagnosis, risk stratification, and therapeutic decision-making across a broad spectrum of cardiovascular diseases. Its extensive clinical validation, ease of acquisition, and reproducibility have established two-dimensional echocardiography as the first-line modality for evaluating left ventricular systolic function.^,

However, advances in cardiovascular imaging have demonstrated that myocardial function cannot be fully characterized by a single volumetric parameter. Although LVEF remains a robust marker of global left ventricular performance, its dependence on loading conditions and its limited sensitivity for detecting early contractile abnormalities underscore the need for a more comprehensive functional assessment.

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