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Left ventricular systolic dysfunction is a commonly recognized cause of heart failure. Widely available techniques can quantitate the left ventricular ejection fraction and estimate the degree of systolic dysfunction. Although diastolic dysfunction is also a common cause of heart failure, no consensus exists regarding optimal techniques to quantitate the degree of dysfunction or to reliably make the diagnosis. Other causes of heart failure are less common. Therefore, many clinical trials of heart failure have included only patients in whom heart failure could be confirmed with documented left ventricular systolic dysfunction.