Echocardiography allows the assessment of systolic and diastolic function and identifies many of the common causes of HF. Patients with minimally symptomatic or unsuspected LV systolic dysfunction may be identified and receive the benefits of ACEI therapy. Echocardiography is also useful for assessing the prognosis and can be used serially to evaluate the effectiveness of treatment. Ventricular filling pressures, pulmonary artery pressures, and cardiac output can be sequentially determined. The authors believe that all patients with HF should receive careful assessment with 2DE, M-mode echocardiography, and Doppler echocardiography (with strategic use of contrast and 3DE where available) (Box 2). Furthermore, the authors believe the use of echocardiography is especially valuable in the elderly who have the poorest prognosis and are more likely to have HF with a normal LV EF or a reduced LV EF and no clinical symptoms. © 2006 Elsevier Inc. All rights reserved.