Heart failure with a normal ejection fraction, also called heart failure with preserved ejection fraction or diastolic heart failure, is thought to be characterized by normal systolic function and disturbed diastolic function only. However, studies using newer Doppler-echocardiographic techniques have shown that ventricular function is not normal particularly in the long axis. Ejection is relatively preserved because of increased radial function. Similar findings are seen with normal ageing and the typical precursors of heart failure with a normal ejection fraction such as hypertension, diabetes, and ischemia. There appears to be a spectrum of abnormalities of systolic function from the truly normal to systolic heart failure with heart failure with a normal ejection fraction occupying an intermediate position. The use of ejection fraction, which has a normal distribution, to dichotomize patients with heart failure is not supported on theoretical or experimental grounds, and any cutoff is arbitrary. Patients with heart failure have a mixture of systolic and diastolic abnormalities and variable degrees of remodeling. It is more important to correctly identify these in the individual patient.