Echocardiography is an essential facet of monitoring patients with heart failure. However, results of echocardiographic detection and quantification of mechanical dyssynchrony are not currently recommended as grounds for the deployment of biventricular (Biv) resynchronisation therapy. Ten years of research in the field of dyssynchrony within echocardiography have resulted in two negative studies which have, to some extent, discredited this technique. However, the research conducted has at least allowed us to refine our understanding of mechanical dyssynchrony and its management. New quantification techniques and generalised access to digital imagery and processing have renewed hopes that the performance of echocardiography in this field will soon improve. We therefore propose new criteria, to be evaluated as per PROSPECT standard methodology. In the review of the literature presented here, we suggest combining the echocardiography parameters for an individual and physiopathological approach, while waiting for more prospective studies to be conducted before issuing any recommendations.