Background : We have previously shown that, LV vortex flow analysis by contrast echocardiography(CE) is feasible and show different flow patterns in normals and patients with systolic heart failure (HF). However, there has been no study about relationship between LV vortex flow patterns and symptomatic status of HF patients. The purpose of this study was to evaluate implication of quantitative LV vortex flow analysis by CE in patients with symptomatic and asymptomatic systolic HF. Methods : A total of 35 patients (21 men; age, 58짹13 years) with LV systolic HF underwent 2-D CE with infusion of Definity (MI of 0.4-0.7) in the apical views. Of the 35 patients, 23 patients had symptoms (group 1) and 12 patients was asymptomatic (group 2). Velocity vector and vorticity was measured by particle image velocitimetry (PIV) combined with a Feature Tracking Algorithm. LV vorticity was estimated by PIV. We measured morphology parameters (vortex length, width, and sphericity index) and pulsatility parameters (relative strength, RS, vortex relative strength, VRS) of vortex. We measured LVEDP by cardiac catheterization. Results : Conventional echo-Doppler parameters did not show significant differences between two groups. However, LV vortex pulsatility parameter, VRS was significantly increased in asymptomatic group than symptomatic group ( 0.79 짹 0.1 vs 0.59 짹 0.2, p=0.03 respectively). LVEDP measured by cath was well correlated with RS (r=-0.727, p=0.01). Figure shows of steady streaming field (left panel), and the pulsatile strength field (right panel) in asymptomatic HF (A), and symptomatic HF (B). Conclusion : The data from this study show that LV vortex pulsatility parameters are more predictive of symptoms than conventional echo-Doppler measures.