Background It is uncertain if assessment of ventricular longitudinal contractility (LC) by tissue Doppler imaging (TDI) can predict functional improvement (FI) of LV dysfunction from medical treatment. Methods & Results TDI was performed in 35 patients with non-ischemic LV dysfunction(EF 26짹8%) and LC was assessed at the 4 basal segments of the LV by myocardial velocity curves (MVC) and strain measurements. Fourteen patients with peak or delayed systolic velocity > 2.0 cm/s with concomitant negative strain (type 1 or 2) at 3 or more segments were classified as group A, and the 21 remaining patients with variable combinations of different MVC types as group B. FI was defined as an EF increase >10% using follow-up Echo. Ten patients (29%) showed an EF increase, from 28짹6% to 51짹9%. Initial LVEF was similar in patients who did and did not achieve FI. QRS interval of group A was shorter than that of group B (102짹32 vs 136짹29 ms, p=0.003) despite similar prevalence of LBBB (29% vs 57%, p=0.166). Group A showed a higher rate of FI (57%[8/14] vs 10%[2/21], p<0.05). Other factors associated with FI were absence of LBBB, narrow QRS duration, and short symptom duration. Stepwise logistic regression analysis revealed that the MVC pattern of group A (OR= 25.5, 95% CI = 2.2 – 298.5, p=0.010) and symptom duration < 2 years (OR= 21.3, 95% CI = 1.8 – 253.3, p=0.015) were independent predictors of FI. Conclusion The concomitant analysis of MVC with strain is useful for predicting FI in severe LV dysfunction.