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catheterization and coronary angiography, which revealed significant three-vessel disease. Two years previously, he underwent placement of an implantable cardioverter defibrillator with biventricular pacing following episodes of ventricular tachycardia. His additional medical problems included hypertension, dyslipidemia, chronic obstructive pulmonary disease, and chronic renal impairment.

On physical examination, he was tachypneic (respiratory rate >40 breaths/min) with a regular pulse of 62 bpm, and blood pressure measuring 180/90 mmHg. His oxygen saturation on pulse oximetry was 93% on room air. He was afebrile and acyanotic. His jugular venous pressure was elevated and inspiratory crackles were heard halfway up both lung fields posteriorly. His chest X-ray showed signs of pulmonary edema with enlarged cardiac silhouette. Echocardiography assessment of left ventricular function revealed a moderately dilated left ventricle (LV) with severely reduced global systolic function with regional variation. Select images from his echocardiogram are shown in Fig. 1A-D (please see companion DVD for corresponding video).

A major clinical application of echocardiography is the assessment of ventricular systolic function. This is a fundamental part of the standard echocardiography examination, but is especially important in patients with heart failure and post-myocardial infarction (Fig. 2). Two-dimensional (2D) and Doppler echocardiogra-phy plays important roles in the diagnosis, management, and risk stratification of patients with systolic dysfunction.

Common causes of LV dysfunction in industrialized countries are listed in Table 1. Precipitating factors

Stage; Stage 1

Wall Scaring

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