Tissue Doppler imaging (TDI) has evolved to become a useful noninvasive method that can complement other echocardiographic techniques in the assessment of left ventricular myocardial velocities in a variety of clinical conditions. Color 2-dimensional and color M-mode TDI are used for quantification of systolic myocardial velocities during myocardial ischemia at rest and with pharmacologic stress testing. Spectral pulsed TDI can provide measurements of regional systolic and diastolic myocardial velocities, and it is particularly useful in the identification of abnormalities of left ventricular diastolic relaxation. This review summarizes the clinical applications of TDI to promote understanding of its utility in the evaluation of left ventricular myocardial function.