This article discusses currently available radionuclide techniques in the diagnostic and prognostic evaluation of patients with chronic heart failure, with a focus on stage B/asymptomatic left ventricular dysfunction. Radionuclide imaging is promising for such patients because it can simultaneously determine left ventricular function, evaluate for the presence of obstructive coronary disease, determine the extent of viable myocardium, and evaluate dyssynchronous left ventricular contraction. Radionuclide imaging can thus provide important noninvasive insights into the pathophysiology, prognosis, and management of patients with asymptomatic left ventricular dysfunction as well as more advanced heat failure.