<International Circulation>: In clinical practice， it is difficult， if not inappropriate， to diagnose based on signs and symptoms alone prior to performing echo or other examinations. Please tell us about the role of echocardiography in the diagnosis of heart failure.

    Prof. Ryan:  We were all taught that heart failure is a clinical diagnosis and certainly the clinical part is important， but as you point out， we almost always rely on some form of imaging to confirm what we suspect clinically. To do that， I believe that echo is the most versatile first-line diagnostic test for evaluating patients with heart failure simply because it addresses both quantitatively and qualitatively all of the possibilities that might fall under the general heading of heart failure.

    <International Circulation>:  Other than echocardiography， what other imaging techniques for diagnosing heart failure are available in clinical practice?

    Prof. Ryan:  Very importantly， there has been a lot of development and growth in MRI， which is an exciting new technology. Not as available. Certainly expensive. Not applicable to patients with devices such as pacemakers and defibrillators. But still a very versatile technique which provides some unique information that echo does not provide. For an initial presentation， most clinicians would rely on echocardiography， as it is established， it is available， it is more cost effective and it has a proven track record.

    <International Circulation>:  Echocardiography and other imaging modalities can evaluate the size of the heart cavity and ejection fraction and at the same time， can demonstrate wall and valve motion. What degree of accuracy is afforded by echocardiography and other imaging modalities in diagnosing heart failure?

    Prof. Ryan: They are the tools we use and rely on， so in that respect， they provide reliable accuracy. For example， for assessing ejection fraction， probably the most accurate technique is MRI. In most clinical trials， it is the gold standard. Echo， and particularly three-dimensional echocardiography， comes very close in terms of accuracy and certainly has an advantage in the assessment of diastolic dysfunction. I would say they are accurate but more importantly they are very versatile and allow us to assess etiology as well as severity.