In the last years there has been an appreciation of the importance of left ventricular geometry. After a period, in the sixties and seventies, that the interest was focused on cardiac physiology and the left ventricular geometry role about this subject, new studies are available on clinical significance of normal or distorted left ventricular shape. New assessment methods of ventricular geometry have been described. The use of simple measurements to assess ventricular geometry has allowed to know the clinical value of the shape distortion in patients with heart failure. The suspicion that left ventricular shape change to sphericity has prognosis value, has raised the interest about this subject. Whether distortion of left ventricular shape is an even better parameter than cardiac function indices normally used is under consideration. Moreover, new surgical therapies have been developed in an attempt to improve the ventricular geometry and to get better clinical prognosis in patients with heart failure.