Cardiac ascites is frequently diagnosed, but there is a paucity of data regarding the predictors for its formation. In a group of patients with heart failure referred for orthotopic heart transplantation and ventricular assist device (VAD) placement, we attempted to identify patient characteristics and predictors associated with the development of ascites. Long-term outcomes of patients with and without ascites were examined. Patients were divided into 2 groups based on the presence or absence of significant ascites on imaging. Demographic information, laboratory values, and results of transthoracic echocardiograms and right-sided cardiac catheterizations were compared between the groups. Of the 196 patients, 29 patients (15%) had significant ascites. The group with significant ascites had higher mean creatinine (2.3 vs 1.6 mg/dl, p = 0.03). On transthoracic echocardiograms, the group with significant ascites had more severe right ventricular dilation (p = 0.03) and tricuspid valve regurgitation (p <0.01). On right-sided cardiac catheterizations, the group with significant ascites had higher mean right atrial (RA) pressure (17 vs 13 mm Hg, p = 0.01). There was no difference in pulmonary capillary wedge pressure between the groups (22 vs 23 mm Hg, p = 0.57). No threshold value of RA pressure was identified for the development of significant ascites. The presence of significant ascites was associated with decreased overall survival (p <0.01). In conclusion, impaired renal function and elevated right-sided cardiac pressures were more commonly seen in the group with significant ascites. No minimum RA pressure elevation was required for significant ascites formation. The presence of significant ascites was correlated with higher mortality.