Echocardiography and serum natriuretic peptide measurement can help to diagnose and monitor heart failure. Echocardiography uses sound waves to take pictures of the heart and assess its pumping and relaxation functions. When pumping function is impaired, the cause of heart failure is left ventricular systolic dysfunction. When pumping function is preserved but there is evidence of impaired relaxation of the heart, heart failure is associated with preserved ejection fraction. Serum natriuretic peptide measurement involves a blood test; levels are classified as normal, raised (somewhat abnormal), or high (very abnormal).