Echocardiography when combined with spectral and colour flow Doppler is well established as a safe, non-invasive, and versatile diagnostic modality in cardiology, and is now the predominant technique used for evaluation of left ventricular function and for the assessment and quantification of valvar heart lesions. When combined with physiological or pharmacological stress, echocardiography also enables the identification of reversible myocardial ischaemia and myocardial contractile reserve.1 2 However, assessment of regional cardiac dysfunction at rest and during stress remains subjective and semiquantitative, with high interobserver variability.3-6

Doppler measurement of myocardial motion, using pulsed wave Doppler, was first proposed in 1989 but this technique allowed real time visualisation of only a single myocardial segment and its potential was not realised.7 Only later, with the development of colour flow algorithms to visualise myocardial motion, did the technique begin to gain clinical acceptability.8-10 Subsequent software development has led to improved temporal and spatial resolution and off line processing to enable quantification of multiple segments of myocardium in seconds. These technological advances have been matched by widespread clinical interest in the technique and an explosion of clinical research. We review the current state of knowledge of tissue Doppler imaging, emphasising current clinical applications and likely future roles.