Response to Latest British Society of Echocardiography recommendations for left ventricular ejection fraction categorisation: potential implications and relevance to contemporary heart failure management.

We thank Dr Kanagala and Professor Squire for their keen interest in our paper and their insight into the challenge of grading left ventricular ejection fraction (LVEF). We must emphasise that our paper's remit was not to be a clinical guide on heart failure nor on its treatment. We have briefly outlined the rationale and context for the BSE cutoff for severe LVEF and why we continue to differ from our European and American colleagues. We then discuss the need for stating the actual LVEF% in reports as opposed to a category alone for guiding appropriate therapeutic choices. Finally we address the concerns raised over clinical harm they perceive may occur from adopting our guideline.