Guideline and consensus documents have recently been published on the important topic of the noninvasive evaluation of patients presenting with chest pain or patients with known acute or chronic coronary syndromes. Authors for these documents have included members representing multispecialty imaging societies. Yet, the process of generating consensus and the need to produce concise written documents have led to a situation where the particular advantages of echocardiography are overlooked. Broad guidelines such as these can be helpful when it comes to "when to do" noninvasive cardiac testing, but they do not pretend to offer nuances on "how to do" noninvasive cardiac testing. This report details the particular value of echocardiography and potential explanations for its understated role in recent guidelines. This report is categorized into the following sections: (1) impact of the level of evidence (LOE) in guideline creation; (2) versatility of echocardiography in the assessment of chest pain (CP) and the inimitable role for echo Doppler echocardiography in the assessment of dyspnea; (3) value of point-of-care ultrasound (POCUS) in assessing CP and dyspnea; and (4) the future role of echocardiography in ischemic heart disease.
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