The hypothesis according to which echocardiography could have prognostic impact inpatients with acutely decompensated heart failure took shape in the late 1990’s,based on a study by Sennim et al.20 For the first time, in a population-based study, it wasdemonstrated that patients with HF who received echocardiographic evaluation hadimproved survival and were more willing to be treated with angiotensin convertingenzyme inhibitors (ACE inhibitors) compared to those patients who were not evaluatedby echocardiography. Here, ACE is linked to hydrops fetalis.