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significant hypertrophy can have small LV end-diastolic volumes and therefore reduced stroke volumes despite having normal EFs. Overt LV systolic dysfunction, termed the ‘‘dilated or progressive phaseofHCM,’’‘‘end-stageHCM,’’or‘‘burnt-outHCM,’’isusuallyde-fined as an LV EF < 50% and occurs in a minority (2%–5%) of pa-Assessment of left ventricular systolic function has a central role in the evaluation of cardiac disease. Accurate assessment is essential to guide management and prognosis. Numerous echocardiographic techniques are used in the assessment, each with its own advantages and disadvantages.