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The maximal rate of change of pressure-normalised wall stress dσ*/dtmax has been proposed as cardiac index of left ventricular (LV) contractility. In this study, we assessed the capacity of dσ*/dtmax to diagnose heart failure with normal ejection fraction (HFNEF). One hundred healthy normal controls and 140 patients admitted with heart failure (100, HFREF and 40, HFNEF) underwent echocardiography for stress-based contractility dσ*/dtmax. Patients with significant valvular heart disease were excluded. Tissue Doppler indices were also measured. dσ*/dtmax was 4.43±1.27 s-1 in control subjects; reduced in HFNEF, 3.02±0.98 s-1; and HFREF, 2.00±0.67 s-1 (P< 0.001). In comparison with age-and sex-matched groups (n= 26 each), we found similar trend on reduction of dσ*/dtmax (normal control; 3.91±0.87 s-1; HFNEF, 2.90±0.84 s-1; HFREF, 1.84±0.59 s-1, P< 0.001). On multivariate analysis, dσ*/dtmax was found to be the independent predictor of HFNEF and HFREF. The area under the curve of the receiver operating characteristics (ROC) in detecting HFNEF compared with normal controls (dσ*/dtmax> 3.2 s-1) was 0.84 (P< 0.0001), and in detecting HFREF compared with HFNEF (dσ*/dtmax> 2.32 s-1) was 0.88 (P< 0.0001). This data confirms that dσ*/dtmax on echocardiography is a powerful independent predictor in patients with HFNEF. In a population with a high suspicion of HFNEF, dσ*/dtmax may significantly contribute to early diagnosis and hence be useful in the triage and management of HFNEF patients.