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There is no definitive consensus on the normal value, as it is affected by age, gender, race, measurement method, and so forth. It is calculated by subtracting the end-systolic LV volume from the end-diastolic LV volume and dividing it by the end-diastolic LV volume. LVEF is an index of LV contractility that indicates the degree of change in LV volume from diastole to systole. In this review, we focus on the standardization of LVEF using reference images and automated LVEF using artificial intelligence (AI). Development of an automatic analysis tool for echocardiographic images is desired as a decision support system. Recently, in an environment with a rapidly increasing number of confirmed/suspected COVID-19 patients, non-specialists, such as emergency physicians, are more likely required to perform this examination in the infection control room. In the intensive care unit, there are cases in which it is necessary to make a visual judgment of function using echocardiographic images due to time constraints. In addition, due to an aging population and the prevalence of lifestyle-related diseases, the number of patients who visit hospitals for cardiovascular diseases is very high. To solve these problems, methods for standardization of LVEF by sharing reference images among observers and artificial intelligence for accurate measurements have been developed. However, notable limitations to LVEF include poor inter-observer reproducibility dependent on observer skill, poor acoustic windows, and variations in measurement techniques. This is a typical example in which LVEF is an important index in cardiovascular clinical practice. On the other hand, routine administration of RAS inhibitors or beta-blockers is not recommended for heart failure with preserved ejection fraction. For example, in the case of heart failure with reduced ejection fraction, renin-angiotensin system (RAS) inhibitors or beta-blockers have been shown to improve the prognosis. Its role in multiple fields (e.g., valvular heart disease, myocardial infarction, cancer therapy-related cardiac dysfunction) has been a mainstay in guidelines. Despite recent advances in imaging for myocardial deformation, left ventricular ejection fraction (LVEF) is still the most important index for systolic function in daily practice.