This measure addresses appropriate evaluation of left ventricular structure and systolic function with TTE to guide heart failure and cardiomyopathy management on patients 18 years of age or older. This is a multi-strata measure consisting of the following strata: 1. Percentage (%) of comprehensive transthoracic echocardiogram (TTE) studies performed on patients with heart failure/cardiomyopathy as the reason for the study, and including the following parameters for the study: - LV end-diastolic and end systolic diameters, end diastolic LV interventricular septum thickness and LV posterior wall thickness measurements - LV mass index calculation - Strain technology utilization - Use of intravenous contrast agent to visualize endocardial borders for LV volumes and ejection fraction (EF) measurement in technically difficult studies 2. Percentage (%) of comprehensive TTE studies performed on patients with heart failure/cardiomyopathy as the reason for the study where the LVEF < 40%, that include a recommendation to consider instituting guideline-directed medical therapy for heart failure, including beta-blocker and renin-angiotensin-aldosterone neurohormonal axis blockade and neprilysn/angiotensin receptor inhibitor if clinically indicated. The overall performance will be calculated using a weighted average. Performance Rate Descriptions: 1. Percentage (%) of comprehensive transthoracic echocardiogram (TTE) studies performed on patients with heart failure/cardiomyopathy as the reason for the study, and including the following parameters for the study: - LV end-diastolic and end systolic diameters, end diastolic LV interventricular septum thickness and LV posterior wall thickness measurements - LV mass index calculation - Strain technology utilization - Use of intravenous contrast agent to visualize endocardial borders for LV volumes and ejection fraction (EF) measurement in technically difficult studies 2 - Percentage (%) of comprehensive TTE studies performed on patients with heart failure/cardiomyopathy as the reason for the study where the LVEF < 40%, that include a recommendation to consider instituting guideline-directed medical therapy for heart failure, including beta-blocker and renin-angiotensin-aldosterone neurohormonal axis blockade and neprilysn/angiotensin receptor inhibitor if clinically indicated. The overall performance will be calculated using a weighted average.