purpose: The overall prognosis for patients with congestive heart failure is poor. Defining specific populations that might demonstrate improved survival has been difficult. We therefore examined our patient database for patients with congestive heart failure who demonstrated sustained improvement in left ventricular function and associated resolution of signs and symptoms of congestive heart failure. patients and methods: We identified 11 patients with severe congestive heart failure (average ejection fraction 21.9 ± 4.23% (± SD) who developed spontaneous, marked improvement over a period of follow-up lasting 4.25 ± 1.49 years. All 11 patients were initially symptomatic with exertional dyspnea and fatigue for a minimum duration of 3 months. They form a subset of a larger group of 97 patients with chronic congestive heart failure that we have followed with sequential ejection fraction measurements. All 11 patients were treated with digitalis diuretics, and either converting-enzyme inhibitors or a combination of isosorbide dinitrate and hydralazine. Ten of the 11 patients had a history consistent with chronic alcoholism, and each reportedly abstained from alcohol during follow-up. results: During the follow-up period, the average ejection fraction improved in 11 patients from 21.9 ± 4.23% to 56.64 ± 10.22%. Late follow-up indicates an average ejection fraction of 52.6 ± 8.55% for the group. Congestive heart failure resolved in each case. conclusions: We conclude that selected patients with severe congestive heart failure can markedly improve their left ventricular function in association with complete resolution of heart failure. This appears to be particularly evident in those patients with chronic alcoholism who subsequently abstain.