The predictive value of serial Doppler echocardiographic follow-up of transmitral flow patterns for the prognosis of patients with congestive heart failure who presented with pulmonary edema was evaluated in 80 consecutive patients with decreased left ventricular systolic function (ejection fraction < 40%). Restrictive patterns [peak early diastolic filling velocity (E)/peak late diastolic filling velocity (A) ratio (E/A) > 2 and/or deceleration time for E wave to decline to baseline (DcT) < 150 msec] were observed in 72 patients (90%) on admission. After intensive therapy, DcT showed a nonrestrictive pattern in 38 of 72 patients (53%). The survival rates at 1 year was 50% for the restrictive group, and 97% for the nonrestrictive group. E/A showed a nonrestrictive pattern in 37 of 56 patients (66%). The survival rates at 1 year was 86% for the restrictive group, and 58% for the nonrestrictive group. Serial Doppler echocardiographic follow-up of transmitral flow patterns is useful in predicting the prognosis in patients with congestive heart failure who presented with pulmonary edema.