One point is awarded for each of the following variables: male sex, typical angina, history and electrocardiographic evi- dence of MI, and diabetes mellitus and use of insulin. Each curve shows the probability of severe coronary disease as a function of age. Reproduced from Hubbard et al.249 assessment of LV function in patients with a normal ECG, no history of MI, no symptoms or signs suggestive of heart failure, and no complex ventric- ular arrhythmias. (Level of Evidence: C) 2. Routine reassessment (<1 year) of LV function with technologies such as echocardiography radionuclide imaging, CMR, or cardiac CT is not recommended in patients with no change in clinical status and for whom no change in therapy is contemplated. (Level of Evidence: C) See Online Data Supplement 2 for additional data on using resting imaging to assess cardiac structure and function. In the presence of signs or symptoms suggestive of heart failure, it is imperative to obtain an objective measure of LV function if a prognosis-altering change in therapy could be based on the findings. For example, a rest ejection fraction (EF) ,35% is associated with an annual mortality rate .3% per year.260 Resting 2-dimensional echocardiography with Doppler echocardiography is the preferred approach because it provides a thorough assessment of all aspects of cardiac structure and function, including identifying the mechanism of heart failure and differentiating systolic LV from diastolic dysfunction. Rest imaging also can provide valuable therapeutic guidance and prognostic information in patients without symptoms or signs of ventricular dysfunction or changing clinical status, especially in those with evidence of other forms of heart disease (eg, hypertensive, valvular). 