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Patients with heart failure and left ventricular (LV) dysfunction continue to have an adverse prognosis. A number of clinical tools are helpful in identifying patients at particularly increased risk, and echocardiography is a remarkably powerful predictor of outcome.1 In addition to the established role of ejection fraction and LV volumes, shape and filling characteristics, left atrial size, mitral regurgitation and haemodynamics2 are predictors of recurrent heart failure and death. The extent of scar, viable myocardium and ischaemia are important determinants that can be added from stress and contrast echocardiography. Recent technical advances including the measurement of global longitudinal strain have added incremental information,3 4 perhaps of most value in patients with mild LV impairment, where the ejection fraction is a less reliable predictor of outcome.
In addition to its adverse functional correlates,5 left bundle branch block has long been a recognised marker of increased risk in heart failure.6 The initial paper linking …