Assessment of left ventricular systolic function by way of ejection function (LVEF) remains the foundation of cardiac imaging. Whether in the field of cardio-oncology, candidacy for device implantation, or left ventricular response to complex structural intervention, there is often no single piece of data more highly impactful on a patient’s cardiovascular treatment and prognosis than LVEF. The expectation of the clinician, as well as the imaging tools locally available, will dictate what imaging modality may be ordered—often with multiple modalities selected, each informing the clinical scenario through their unique advantages and disadvantages (Figure 1).