Objectives: We performed a prospective analysis to identify the association between myocardial synchronicity measured by tissue Doppler imaging (DTI) and prognosis in patients with severe congestive heart failure (CHF) Methods: One hundred forty patients (age 65짹2) with severe CHF (NYHA class 3 or 4, ejection fraction (EF) <35%) were followed serially. DTI was performed using 5-basal, 5-mid segments to assess the time to peak systolic points from R wave on EKG (RS time). The standard deviation (SD) of RS time of 10 segments was considered an indicator of myocardial synchronicity. Two groups, on the SD of RS time < 40 or > 40, were identified. Primary end points were the ventricular arrhythmia, death, and readmission due to worsening of CHF. Results: After 17짹10 months follow up, fifty-five patients (39.2%) met the primary end points. Prolonged SD of RS time was associated with a significant increase in mortality (30% vs 13%, p<0.01) or composite primary end points (58% vs 25%, p<0.001). Mean event free survival was 29.4 months (95% CI 25.9-32.9 months) in patients with SD <40, 17.9 months (95% CI 13.9-21.8 months) in SD >40 respectively (p<0.001). After adjustment for baseline variables, SD of RS time was independent risk factor of primary end points. Conclusion: Myocardial synchronicity measured by DTI is associated with prognosis of severe CHF.