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Evolution of diagnostic testing modalities in cardiovascular medicine has been rapid. Technological advances in cardiac imaging have enabled the assessment of cardiac texture and function with unprecedented resolution, while the assessment of coronary artery disease by non-invasive means has matured to rival coronary angiography. Similarly, developments in the area of serum biomarkers have given further insights into the risk experienced by patients with coronary artery disease, acute coronary syndromes and heart failure. However, the rate of this innovation calls for a moment''s pause to refocus on the goals of the diagnostic and risk refinement process that is to deliver better care and improve clinical outcome. To date many studies in this area have fallen short of demonstrating such benefits and it is our responsibility as a clinical community to demand more of such innovation. [Copyright &y& Elsevier]