Background: The elderly population (���65 years old) is increasing and the incidence and prevalence of congestive heart failure escalates with age. However, clinical characteristics of elderly patients (pts) (EPs) with newly diagnosed - acute decompensated heart failure (ND-ADHF) are not clarified yet. The aim of this study is to determine the characteristic initial presentation of ND-ADHF of the EP compared with non-elderly pts (NEPs). Methods and Results: Two hundred fifty six pts (153 male pts) who admitted to our hospital between January 2005 and March 2009 due to ND-ADHF were investigated. The clinical characteristics and echocardiographic parameters were analyzed in the EPs (mean age 74.0짹6.9 years old) and NEPs (mean age 50.6짹10.8 year old). In intergroup comparison, body mass index (22.3짹4.5 vs. 24.0짹4.4 kg/m2), estimated glomerular filtration rate (54.8짹24.3 vs. 69.2짹30.7 ml/min/m2), C-reactive protein (28.5짹46.9 vs. 7.6짹11.6 mg/dL) and hemoglobin (12.3짹2.1 vs. 13.6짹2.3 mg/dL) level were significantly different (p<0.05). The left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD) were significantly less dilated (LVEDD: 57.6짹11.3 vs. 62.0짹10.9 mm and LVESD: 48.1짹11.1 vs. 52.1짹11.7 mm) in EPs (p<0.05) than those of NEPs. However, diastolic dysfunction was more severe in EPs (E/E���: 21.7짹9.4 vs. 18.0짹8.9; E���: 4.0짹1.3 vs. 5.2짹1.9 cm/sec than NEPs (p<0.05). Conclusion: The EPs with ND-ADHF have different clinical characteristics compared with NEPs and diastolic dysfunction is more problematic than systolic dysfunction in these pts.