The assessment of left ventricular ejection fraction is a key clinical investigation guiding the diagnosis, management and prognosis of cardiology patients. Echocardiography is an inexpensive, safe, and portable method commonly used to provide this information. Improvement in the quality of assessment provided by echocardiography continues to be the subject of current clinical programs and investigations. Contrast-enhanced echocardiography is an established method to reduce both inter- and intra-observer variability in the echocardiography lab. The implementation of teaching interventions has also been shown to reduce variability in the qualitative and quantitative assessment of ejection fraction. Newer investigative methods, such as 3D imaging and speckle tracking, show promise as tools to further enhance the quality of left ventricular ejection fraction assessment in the echocardiography lab.