Doppler tissue imaging is a new noninvasive imaging modality that allows quantitation of the low intensity, high amplitude Doppler shifts in the range of myocardial tissue motion. This study was performed to test the hypothesis that Doppler tissue imaging may provide unique information reflecting left ventricular systolic function, and to test the relationship between myocardial tissue velocity and noninvasive measures of ventricular contractility. Nine patients with mild or moderate mitral insufficiency and no regional wall motion abnormality were studied during dobutamine stress echocardiography. Left ventricular ejection fraction and peak systolic velocity of the sub-endocardial left ventricular posterior wall were quantified at baseline and at peak stress and compared with estimated peak dP/dt. During dobutamine infusion, ejection fraction increased from 41.7 +/- 22.2 (range 14 to 70) % to 56.6 +/- 27.9 (range 17 to 84)% (p = 0.001), peak systolic velocity increased from 22.7 +/- 4.2 (range 18 to 28) mm/sec to 35.3 +/- 10.1 (range 20 to 47) mm/sec (p = 0.004), and dP/dt increased from 1050 +/- 322 (range 613 to 1574) mm Hg/sec to 1766 +/- 768 (range 936 to 3000) mm Hg/sec (p = 0.01). Although there were good correlations between left ventricular dP/dt and both ejection fraction (R = 0.75) and peak systolic velocity (R = 0.81), the correlation between change in dP/dt and change in myocardial velocity (R = 0.75) was better than that between change in dP/dt and change in ejection fraction (R = 0.36). These data support the hypothesis that myocardial velocity determined with Doppler tissue imaging reflects myocardial contractility, and that catecholamine-induced alteration in contractility is better reflected by changes in myocardial velocity than by changes in ejection fraction.