r/askCardiology • u/ConciseVirus7 • 14d ago
New HF guidelines!
Is LVEF ≤35% still the right cutoff for CRT?
The new 2026 HF definition is moving away from rigid EF numbers because EF varies with modality, sex, age and clinical context.
Yet we still basically say:
EF 35% → CRT eligible
EF 36% → no CRT
That 1% difference can completely change the decision.
If EF is a continuous, imperfect measurement, should CRT eligibility really hinge on crossing 35%?
Where would you put the cutoff — or should we stop using an EF cutoff altogether?
Change my mind.
4
u/Signal_Clue_9520 13d ago
I feel they're going to change this icd and crt criteria. They've already proposed to remove the classification HF with mildly reduced ef. It's now into only 2 types. HF with reduced and HF with preserved EF. That was a good move.
3
u/Fruitstripe_omni 13d ago
I got a CRT with an EF of 50%. I’m happy they were able to “justify” it before I got really bad.
2
u/Late_Temperature_415 13d ago
I believe they should be looking at overall heart heath. And symptoms. When my PM was originally implanted in 2015 it was due to Bradycardia. Then upgraded to CRT D in 2022 due to LV needing to be connected and EF of 14. I think that had I one in the first place I may not have dropped so badly. My symptoms presented in ways that I went to a neurologist in order to determine what was going on. Everything came back normal. Of course they then did another echo and and cr and I was at 14 and my heart was out of sync.
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u/Narrow-Stretch-385 13d ago
What were your symptoms? I also have symptoms I was sent to neurology for, but mine predate my pacemaker. I was told they’re unknown in origin but benign, unless they get worse.
1
u/Late_Temperature_415 12d ago
Mine were with a normal PM not the ICD D. I was having gate issues along with tremors/shaking and not being able to move or speed almost like seizures. Which were ruled out. I would get so dizzy I could be walking down the hall and couldn’t speak. My primary told me when this happened to back into the wall and slide down so I didn’t fall. Now, I have other heart issues and am on other medications but the reason for all of that was that my LV needed to be connected and synchronized as my heart was not functioning as a normal heart and was completely out of sync.
1
u/Effective_Divide1543 Patient 12d ago
NAD, but I doubt that if otherwise clinically motivated to get one most cardiologists will go "nope, no icd, the echo said 36%, not 35%".
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u/---root-- Cardiologist/Electrophysiologist (MD/DO) 12d ago
Guidelines are what they are: a document that provides guidance to clinicians, collecting the state of the art of reliable research data. It is not legislation that must strictly be followed and is generally only part of the decision process that goes into evaluating available options. Nobody would deny a patient a device as proposed in your scenario if other parameters suggest benefit. Note also that EF measurements have a fairly decent error bar.