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The most common cause of left ventricular failure is ischemic heart disease. This condition arises primarily from a reduction in blood flow to the heart muscle, often due to coronary artery disease (CAD). When the heart receives inadequate oxygen and nutrients, it can lead to damage of the heart tissue, resulting in reduced contractility and ultimately left ventricular failure.

In patients with ischemic heart disease, the heart struggles to pump effectively, which may lead to heart failure as the left ventricle cannot maintain adequate output to meet the body's demands. Additionally, the resultant scarring from previous heart attacks further compromises the heart's ability to function efficiently, making it a predominant contributor to left ventricular failure among the potential causes.

While conditions like hypertension, valvular heart disease, and congestive heart failure also contribute to heart problems and can lead to left ventricular failure, ischemic heart disease remains the leading direct cause among these conditions.