Afterload reduction therapy can acutely improve hemodynamic function in patients with advanced heart failure; however, it is unknown if initial reductions in mitral and tricuspid regurgitation and atrial volumes can be sustained with oral therapy. Atrial volumes and atrioventricular valve regurgitation were measured using 2-dimensional and Doppler echocardiography with color-flow imaging in 14 patients with dilated heart failure (ejection fraction 17 ± 4%) before and after 3 ± 1 days of intensive vasodilator and diuretic therapy tailored to hemodynamic goals. Echocardiography was repeated again after 6 ± 2 months on oral vasodilators and a flexible diuretic regimen. Acute therapy reduced systemic vascular resistance from 1,760 ± 460 to 1,010 ± 310 dynes·s·cm −5, pulmonary artery wedge pressure from 30 ± 5 to 17 ± 4 mm Hg, and right atrial pressure from 13 ± 5 to 7 ± 3 mm Hg, and led to a 61% increase in stroke volume (from 36 ± 10 to 58 ± 14 ml) (p < 0.01). Mitral and tricuspid regurgitation, determined by color-flow fraction, initially decreased from 0.34 ± 0.17 to 0.20 ± 0.20 and from 0.33 ± 0.15 to 0.13 ± 0.13, respectively (p < 0.001). This reduction was sustained at 6 months. Significant decreases occurred with acute therapy, with further reductions at 6 months in both mean left atrial volume (from 100 ± 25 to 80 ± 19 to 65 ± 15 cm 3) and right atrial volume (from 85 ± 23 to 64 ± 23 to 52 ± 14 cm 3) (p < 0.001). Echocardiographic estimate of mean pulmonary artery pressure decreased acutely (from 42 ± 5 to 30 ± 7 mm Hg, p < 0.001), then remained unchanged at follow-up. Congestive symptoms and signs were also markedly improved at 6 months (p < 0.05). In conjunction with clinical improvement in 6-month survivors with advanced heart failure, acute reductions in atrial volumes and atrioventricular valve regurgitation can be sustained on longterm oral vasodilators and diuretics.