Left ventricular (LV) contractile and diastolic performance was evaluated in patients with thermal injury or multiple trauma using precordial and transesophageal echocardiography. Thirty-nine patients were divided into four groups: group B1 (within 24 hours after thermal injury); group B2 (from 24 to 72 hours after thermal injury); group M (multiple trauma); and a control group (outpatients). Left ventricular contractile indices, including ejection fraction, mean velocity of circumferential fiber shortening, and the ratio of systolic blood pressure to LV end-systolic dimension, were not impaired in any of the experimental groups. The ratio of LV filling volume during rapid filling to stroke volume, obtained from M-mode echocardiography as an index of LV distensibility, was significantly decreased in groups B1 (44.5% +/- 8.8%) and B2 (46.8% +/- 8.5%) compared with controls (61.9% +/- 7.4%) (p less than 0.05). The ratio of the peak velocity in the atrial contraction phase to that in the rapid filling phase, obtained using pulsed Doppler echocardiography, also showed significant impairment of LV distensibility in groups B1 (1.08 +/- 0.12) and B2 (1.09 +/- 0.07) compared with controls (0.71 +/- 0.12) (p less than 0.01). Group M showed no significant impairment of these diastolic indices. A profound depression of LV diastolic function thus occurs following thermal injury but not following multiple trauma.