Over 4.7 million Americans have heart failure, and 50000 new cases of heart failure are diagnosed every year. In addition, a significant proportion of the population may have asymptomatic left ventricular (LV) systolic dysfunction. Population studies estimate that the prevalence of asymptomatic LV dysfunction ranges from 0.9-5.9%. Of these, a substantial number will eventually develop symptomatic heart failure. Diagnosing and treating these patients before they develop symptoms may help to delay or prevent the development of symptomatic heart failure. This review highlights the currently available data on the epidemiology, pathophysiology, diagnosis, and treatment of asymptomatic LV systolic dysfunction.