Biplane Simpson EF

Biplane Simpson EF: LV ejection fraction from apical 2- and 4-chamber disk summation method.

Apical 2-Chamber View

LV End-Diastolic Volume (mL)

LV End-Systolic Volume (mL)

Apical 4-Chamber View

LV End-Diastolic Volume (mL)

LV End-Systolic Volume (mL)

Formula

EF = (avg EDV − avg ESV) / avg EDV × 100%

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Primary LV systolic function assessment on transthoracic echo

HF diagnosis and severity stratification

Post-MI LV function assessment

Cardiotoxicity monitoring (chemotherapy, HER2 inhibitors)

Serial monitoring in LVAD candidates

More accurate than M-mode (Teichholz) in most patients

Key Advantages

Less dependent on geometric assumptions vs. M-mode

Validated against cardiac MRI gold standard

Incorporates regional function variations

Recommended by ESC/AHA guidelines as primary measurement

Reproducible across operators with good image quality

Section 2

Formula & Logic

Calculation Methodology

Requires apical 2-chamber and 4-chamber views

Tracings of LV endocardium in diastole and systole

LV volume = Σ cylinder volumes stacked base-to-apex

Formula: EF = (EDV − ESV) / EDV × 100%

Biplane method averages 2- and 4-chamber calculations

LV EF Classification

LVEF (%)	Classification	Clinical Correlate
>50	Normal	No LV dysfunction
41–49	Mildly Reduced	HFmrEF (newer category)
31–40	Moderately Reduced	HFrEF (may be symptomatic)
≤30	Severely Reduced	HFrEF; high risk; LVAD/transplant candidate

Section 3

Pearls/Pitfalls

Technical Considerations

Image quality critical; foreshortened views → artifactually low EF

Apical thrombus can be included accidentally; visual assessment essential

Paradoxical septal motion (post-cardiac surgery) affects accuracy

Normal EF does NOT exclude diastolic dysfunction or HFpEF

Serial EF drop >5% during chemotherapy warrants intervention

Clinical Pitfalls

Foreshortened apical 4-chamber overestimates EF

Excessive papillary muscle inclusion underestimates volumes

Young athlete physiology (eccentric LV hypertrophy) may lower EF slightly

Tachycardia / arrhythmia reduces reproducibility; average multiple beats

Section 4

Next Steps

LVEF >50% (Normal)

Normal LV systolic function; reassess if new symptoms

Assess diastolic function if dyspnoea present

Standard follow-up based on clinical indication

LVEF 41–49% (Mildly Reduced / HFmrEF)

Offers risk for HF progression; optimize BP/HR

Consider SGLT2i therapy per recent guidelines

Annual echo surveillance

Identify and treat reversible causes

LVEF 31–40% (Moderately Reduced)

HFrEF diagnosis; initiate quadruple therapy: ACEi/ARB, β-blocker, MRA, SGLT2i

ICD evaluation if EF expected to remain ≤35% after 40 days therapy

CRT consideration if QRS ≥120 ms + symptoms

3–6 month repeat echo after therapy initiation

LVEF ≤30% (Severely Reduced)

High-risk HFrEF; aggressive pharmacotherapy + device therapy

ICD indicated for primary prevention if stable >40 days

Urgent cardiology consultation; evaluate LVAD/transplant candidacy

Monthly clinical monitoring; repeat echo every 3–6 months

Complementary Calculators

TAPSE (RV Systolic Function)

LV Mass Index

AVA (Continuity Equation)

EROA (PISA Method)

MVA (Pressure Half-Time)

Section 5

Evidence Appraisal

Validation

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Lang RM et al. • J Am Soc Echocardiogr.. 2015;e1-39. The landmark guideline for EF quantification.

Section 6

Literature

Development

Biplane Simpson method has become the standard echocardiographic LV function assessment since the 1990s. Formalized in ASE guideline documents; now universal in echo labs worldwide.

Last Comprehensive Review: 2026

Related Cardiovascular Tools

ABC-AF Bleeding Score

ABC-AF Stroke Score

ABCD2 Score

ADD-RS

Aortic Valve Calcium Score

Blood Pressure Percentiles

Have feedback about this calculator?Let us know.

Biplane Simpson EF

Biplane Simpson EF: LV ejection fraction from apical 2- and 4-chamber disk summation method.

Apical 2-Chamber View

LV End-Diastolic Volume (mL)

LV End-Systolic Volume (mL)

Apical 4-Chamber View

LV End-Diastolic Volume (mL)

LV End-Systolic Volume (mL)

Formula

EF = (avg EDV − avg ESV) / avg EDV × 100%

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Primary LV systolic function assessment on transthoracic echo

HF diagnosis and severity stratification

Post-MI LV function assessment

Cardiotoxicity monitoring (chemotherapy, HER2 inhibitors)

Serial monitoring in LVAD candidates

More accurate than M-mode (Teichholz) in most patients

Key Advantages

Less dependent on geometric assumptions vs. M-mode

Validated against cardiac MRI gold standard

Incorporates regional function variations

Recommended by ESC/AHA guidelines as primary measurement

Reproducible across operators with good image quality

Section 2

Formula & Logic

Calculation Methodology

Requires apical 2-chamber and 4-chamber views

Tracings of LV endocardium in diastole and systole

LV volume = Σ cylinder volumes stacked base-to-apex

Formula: EF = (EDV − ESV) / EDV × 100%

Biplane method averages 2- and 4-chamber calculations

LV EF Classification

LVEF (%)	Classification	Clinical Correlate
>50	Normal	No LV dysfunction
41–49	Mildly Reduced	HFmrEF (newer category)
31–40	Moderately Reduced	HFrEF (may be symptomatic)
≤30	Severely Reduced	HFrEF; high risk; LVAD/transplant candidate

Section 3

Pearls/Pitfalls

Technical Considerations

Image quality critical; foreshortened views → artifactually low EF

Apical thrombus can be included accidentally; visual assessment essential

Paradoxical septal motion (post-cardiac surgery) affects accuracy

Normal EF does NOT exclude diastolic dysfunction or HFpEF

Serial EF drop >5% during chemotherapy warrants intervention

Clinical Pitfalls

Foreshortened apical 4-chamber overestimates EF

Excessive papillary muscle inclusion underestimates volumes

Young athlete physiology (eccentric LV hypertrophy) may lower EF slightly

Tachycardia / arrhythmia reduces reproducibility; average multiple beats

Section 4

Next Steps

LVEF >50% (Normal)

Normal LV systolic function; reassess if new symptoms

Assess diastolic function if dyspnoea present

Standard follow-up based on clinical indication

LVEF 41–49% (Mildly Reduced / HFmrEF)

Offers risk for HF progression; optimize BP/HR

Consider SGLT2i therapy per recent guidelines

Annual echo surveillance

Identify and treat reversible causes

LVEF 31–40% (Moderately Reduced)

HFrEF diagnosis; initiate quadruple therapy: ACEi/ARB, β-blocker, MRA, SGLT2i

ICD evaluation if EF expected to remain ≤35% after 40 days therapy

CRT consideration if QRS ≥120 ms + symptoms

3–6 month repeat echo after therapy initiation

LVEF ≤30% (Severely Reduced)

High-risk HFrEF; aggressive pharmacotherapy + device therapy

ICD indicated for primary prevention if stable >40 days

Urgent cardiology consultation; evaluate LVAD/transplant candidacy

Monthly clinical monitoring; repeat echo every 3–6 months

Complementary Calculators

TAPSE (RV Systolic Function)

LV Mass Index

AVA (Continuity Equation)

EROA (PISA Method)

MVA (Pressure Half-Time)

Section 5

Evidence Appraisal

Validation

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Lang RM et al. • J Am Soc Echocardiogr.. 2015;e1-39. The landmark guideline for EF quantification.

Section 6

Literature

Development

Biplane Simpson method has become the standard echocardiographic LV function assessment since the 1990s. Formalized in ASE guideline documents; now universal in echo labs worldwide.

Last Comprehensive Review: 2026

Related Cardiovascular Tools

ABC-AF Bleeding Score

ABC-AF Stroke Score

ABCD2 Score

ADD-RS

Aortic Valve Calcium Score

Blood Pressure Percentiles

Have feedback about this calculator?Let us know.