Because life expectancy and the prevalence of risk factors such as hypertension, obesity and diabetes are rising globally, heart failure (HF) is growing into a major health problem. Impairment of left ventricular (LV) diastolic function as well as systolic function appear very early in the course of heart disease. Recent HF guidelines, therefore, place special emphasis on the detection of subclinical LV dysfunction and the timely identification of risk factors for HF. Conventional echocardiography combined with new imaging techniques such as tissue Doppler and tissue tracking are sensitive tools to detect early subclinical deterioration of LV function. Community-based studies revealed a higher prevalence of LV systolic and diastolic dysfunction using the new echocardiographic imaging techniques. Future prospective studies will clarify the hitherto unknown prognosis associated with early symptom-free LV dysfunction.