Left Ventricular Ejection Fraction: Simpson's and Teicholz Methods — When to Use Each
Why Simpson's Method is Preferred
According to current guidelines, LVEF should be calculated from EDV and ESV measured using the biplane method of disks summation, also known as the "modified Simpson's method." Volumes are obtained from apical 4- and 2-chamber projections. It is critically important that volume data are not obtained from foreshortened or technically unsatisfactory images (BSE, 2020).
Teicholz Method
A linear calculation method based on cubing the linear dimensions of the LV:
EDV = LVIDd³, ESV = LVIDs³.
EF% = [(LVIDd³ − LVIDs³) / LVIDd³] × 100%.
Normal EF% values by Teicholz: 53–73% (for individuals aged 20+). Linear methods for calculating EDV and ESV by Teicholz and Quinones are no longer recommended (Blagodir, 2024).
Quinones Method
This method accounts for the contractility features of the apex using a correction factor K:
EF% = [(LVIDd² − LVIDs²) / LVIDd²] × 100% + K.
| Apex Condition | Correction Factor K |
|---|---|
| Normal contractility | +10% |
| Hypokinesis of the apex | +5% |
| Akinetic apex | +0% |
| Dyskinesis of the apex | −5% |
| Aneurysm of the apex | −10% |
Normal LVEF values by Quinones: >55–65%.
When to Use Each Method
Linear methods for calculating LV ejection fraction are permissible only in the absence of regional wall motion abnormalities and/or in the presence of diffuse wall hypokinesis. In all other cases, echovolumetric methods (Bullet or disks summation method) should be used (Blagodir, 2024).
Reference Values for LVEF by Simpson
According to BSE (2020), the lower limit of normal LVEF in the NORRE dataset was 53.5% for men and 54.5% for women (the difference is statistically significant, p=0.009); however, BSE maintained unified reference intervals for both genders.
Frequently asked questions
Why is Teicholz no longer recommended?
Linear methods for calculating EDV and ESV by Teicholz and Quinones are no longer recommended; LVEF is better calculated using the biplane method of disks summation (modified Simpson's method).
In which cases are linear methods permissible?
Only in the absence of regional wall motion abnormalities of the LV and/or in the presence of diffuse wall hypokinesis. In all other cases, echovolumetric methods (Bullet or disks summation) should be used.
From which projections are volumes constructed for Simpson's method?
LVEF is derived using the biplane Simpson's method from 2D volumes obtained in apical 4- and 2-chamber views; foreshortened or technically poor images should not be used.
How does the Quinones method account for the apex?
Through a correction factor K: +10% for normal contractility, +5% for hypokinesis, 0% for akinesis, −5% for dyskinesis, −10% for aneurysm of the apex.
What are the normal values for LVEF?
By Teicholz — 53–73% (20+ years), by Quinones — >55–65%. According to BSE (Simpson), the lower limit of normal: 53.5% for men and 54.5% for women.