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aetiology are noted in many patients at the time of echocardiography. Patients with ischaemic aetiology may have regions of akinesis/dyskinesis and thinning/aneurysm formation in the myocardial areas affected by coronary disease. Valvular disease is detected, often also with characteristic valvular findings dependent on cause (e.g. rheumatic or ischaemic), and the long-term sequelae of untreated hypertension may be observed (LV hypertrophy, aortic dilatation with or without central aortic regurgitation). Findings consistent with other cardiomyopathies, cardiac amyloidosis (CA), or ventricular dyssynchrony in left bundle branch block (LBBB) may also be noted.

When considering further investigation for CAD, noninvasive assessment is often sufficient, and before proceeding to invasive assessment the risks and benefits should be considered.178–180

 






  



 

 



 




 

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Figure 5 Major contributing causes of heart failure with reduced ejection fraction. HFrEF, heart failure with reduced ejection fraction. aToxic may include both drug-related and chemotherapy-related causes. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026