Echocardiography is the first line imaging modality in cardiovascular diseases. Its predominant role in clinical care is mainly based on the following factors:

• Universal availability. While it has always been a strength of echocardiography that it could be performed at the bedside with mobile machines, portability has reached a new level with the advent of laptop or even palmtop type devices. These small machines do sacrifice some degree of image quality and a few echo modalities, but an experienced examiner can obtain almost immediately relevant clinical data with such a portable echo machine. Even state-of-the-art machines have been coming down in size and weight, and all are fully mobile and able to function in an emergency ward or intensive care environment.

• Low cost. Typically, state-of-the-art echocardiography machines are available for about 10–20% of the price of competitor techniques such as a gamma camera, magnetic resonance imaging (MRI), or computed tomography (CT). There are only minimal additional material costs per examination. No contrast agent is routinely necessary. The exam can be performed by a sonographer or a physician. Cost effectiveness of stress echocardiography compared to conventional exercise ECG or nuclear imaging in patients with low to intermediate pre-test likelihood has been shown.1 2

• No radiation. Ultrasound for practical purposes can be regarded as biologically safe. Unlike with MRI, the presence of metal implants such as pacemakers poses no hazard.

• Echocardiography is the original ‘one-stop shop’, evaluating global and regional left and right ventricular morphology and function, valvular function, pericardial abnormalities, aortic disease, and other data in real time within minutes. Furthermore, a three dimensional echocardiogram or deformation imaging are done with the same machine during the same examination, adding at most a few minutes to an examination whose typical duration does not exceed about 20 min.