Heart failure with reduced left ventricular ejection fraction (LVEF < 50%) is a major cause of cardiovascular morbidity and mortality. Coronary angiography identifies ischemic etiology and guides therapeutic strategies; however, data from Africa remain limited, especially in Cameroon. This is therefore the very first study to address this topic. To describe the clinical, angiographic, and therapeutic characteristics of patients with heart failure and reduced LVEF undergoing coronary angiography in Yaoundé where the first and sole catheterization laboratory was opened in November 2022. We conducted a descriptive and analytical cross-sectional study over three years (November 2022–November 2025) at the Yaoundé General Hospital. Data were sourced from the DéRICA registry and included consecutive patients admitted for acute coronary syndrome who underwent coronary angiography and presented with reduced LVEF. therapeutic approach. Significant coronary lesions were defined as stenosis ? 50% via quantitative coronary angiography (QCA) and classified according to ACC/AHA criteria. Statistical analysis was performed with a significance threshold of p < 0.05. Among 115 patients explored, 55 presented with reduced LVEF, representing a prevalence of 47.8% in the catheterization laboratory. Coronary arteries were abnormal in 85.5% of patients. The mean age was significantly higher in patients with abnormal coronaries. Single-vessel disease predominated, but a significant proportion of complex lesions was observed. Coronary angioplasty was the primary therapeutic strategy, while non-obstructive conditions (MINOCA, INOCA) and alternative strategies were also noted. Ischemic heart disease is the dominant etiology of heart failure with reduced LVEF in Yaoundé, with a diversity of coronary mechanisms justifying an individualized diagnostic and