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Congestive heart failure (CHF) is the most prevalent disease in the elderly. Despite advances in pharmacological and device therapy, mortality remains high and is more pronounced in the elderly. Reasons for this include the fact that patients with CHF have many organ dysfunctions and are prone to further complications. Because of this polypharmacy and various comorbidities, the CHF population does not necessarily have a common pathophysiological feature. The vast majority of elderly patients with CHF have type II (ischemic) diastolic dysfunction, and >30% also have type IV (right heart failure) diastolic dysfunction. In a recent study by our group, we observed that elderly patients with type II diastolic dysfunction had a more favorable prognosis than patients with type IV diastolic dysfunction [[@B1]]. Accordingly, in the normal aging process, left ventricular (LV) diastolic function deteriorates with age regardless of symptoms or signs, and this involves right ventricular (RV) dysfunction [[@B2]]. A substantial number of elderly patients with CHF have type II diastolic dysfunction, and there are also cases of patients with type IV diastolic dysfunction who do not have symptoms. The current evidence suggests that diastolic dysfunction results in higher LV filling pressure, pulmonary congestion, an increased coronary risk, and an increased risk of hospitalization [[@B3],[@B4]]. The RV also contributes to the pathophysiology of heart failure, and RV function is usually evaluated by measuring the RV systolic pressure [[@B5]]. However, the current guidelines do not recommend the use of RV systolic pressure measurements to determine the indications for device therapy [[@B6]]. Therefore, it is of clinical importance to examine both the LV and RV. These recent studies have focused on the development of new prognostic factors. For example, a strain index was recently shown to be a stronger prognostic factor than LV ejection fraction.

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