Which characteristic is associated with systolic heart failure?

Systolic heart failure, often referred to as heart failure with reduced ejection fraction (HFrEF), is characterized by the heart's inability to contract effectively, leading to a decrease in the ejection fraction. An ejection fraction of 40% or less indicates that the heart is not pumping blood efficiently, which aligns with the definition of systolic heart failure. This reduced ejection fraction is a key indicator of the heart's compromised ability to generate sufficient force during contraction, resulting in symptoms of congestion and poor circulation.

In this context, the association of an ejection fraction of 40% or lower with systolic heart failure distinguishes it from diastolic heart failure, where the ejection fraction may be normal or even elevated but the heart still fails to fill adequately. Other characteristics of systolic heart failure, such as ventricular dilation or increased size of the left ventricle, may also occur as a consequence of long-standing pressure overload or volume overload, but the critical defining feature remains the impaired contractility reflected in the reduced ejection fraction.