The evaluation and management of patients with infiltrative cardiomyopathy remains clinically challenging (table 2). Cardiac involvement in amyloidosis and sarcoidosis is associated with a more adverse prognosis and hence early identification is warranted. Echocardiography, though able to detect gross morphological and functional abnormalities, lacks specificity and sufficient sensitivity. Newer methods using tissue imaging may prove to have a role in the future by their ability to define focal abnormalities and detect subclinical disease. Nuclear imaging is helpful in differentiating sarcoid from other cardiac diseases when symptoms are present, as well as predicting response to treatment. More recently, cardiac MRI has shown promise for all types of infiltrative cardiomyopathy ( figure 6), in not only identifying typical morphological and functional changes, but also in assessing disease activity. However, no imaging technique stands alone, and even the 'gold standard' of endomyocardial biopsy may often not be conclusive, given the focal nature of cardiac in filtration in some cases. The integration of clinical assessment, tissue biopsy and cardiac imaging will still need to form the basis of any future diagnostic framework.