Imaging is helpful for the evaluation of myocardial structure and function, valvular disease, and haemodynamics in heart failure (HF). The assessment of ejection fraction is probably the most important step, as distinction of preserved, reduced, and mid-range ejection fraction has implications for management. In enlarged ventricles, quantification of mitral regurgitation and assessment of left ventricular (LV) shape are important as markers of HF severity. However, it should be remembered that haemodynamic evaluation and the assessment of right ventricular function are of value, independent of ejection fraction. The evaluation of diastolic dysfunction is based on estimation of LV filling pressure and assessment of severity of LV diastolic dysfunction, on the basis of left atrial volume, diastolic stage, and estimation of LV filling pressure (E/eʹ). Diastolic assessment is of value in patients with HF with preserved ejection fraction. LV responses to stress can identify an ischaemic aetiology, as well as left or right ventricular contractile reserve, a prognostic marker in both ischaemic and non-ischaemic cardiomyopathy. In patients with risk factors for HF, the evaluation of myocardial deformation and classification of LV morphology on the basis of relative wall thickness and LV mass, into normal, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy has prognostic value. Cardiac imaging is indispensable in the management of HF, and echocardiography is the most widely used test for this purpose. However, no single test satisfies all imaging requirements in HF.