Heart failure is a common condition that is becoming more prevalent.1 ,2 It could be defined as the inability of the heart to deliver a satisfactory output at normal filling pressures. It is a complex clinical syndrome, usually marked by progressive breathlessness on effort, and often including systemic venous congestion with resulting oedema and hepatic congestion. Clinical heart failure has a poor prognosis,3 and consumes very large amounts of health care resources. There are widespread inaccuracies in diagnosis when clinical methods alone are used, and many patients in whom the diagnosis is made in primary care prove not to have the condition on further investigation.4-6 There is some evidence of increased use of echocardiography in heart failure in UK hospitals.7

It has become clear from recent studies that pharmacological interventions significantly improve outcomes in clinical heart failure due to left ventricular (LV) systolic dysfunction, in asymptomatic LV dysfunction, and following myocardial infarction.8-11Echocardiography is a non-invasive technique well suited to the evaluation of LV function, and most echocardiographic departments find that estimation of LV function occupies an increasing proportion of their workload.

Community studies of LV systolic dysfunction by echocardiography suggest a prevalence of 1.5–1.8% in symptomatic patients aged 25–74 years, depending on whether an ejection fraction of 0.3 or 0.35 was used as the criterion, with many more than that being asymptomatic.12