Background: In chronic renal failure (CRF), troponin T (TnT) lacks specificity in diagnosing acute coronary syndrome but is known to be associated with poor clinical outcome. We investigated the relation between TnT level and echocardiographic functional and anatomical characteristics in CRF. Method: In CRF, we underwent TTE within 1 hour after hemodialysis and following TTE data were obtained: left ventricular ejection fraction (LVEF), left end-diastolic volume (LVEDV), left ventricular mass index (LVMI), left atrial dimension (LAD), aortic root dimension (ARD), mitral flow velocity (E/A), and mitral septal annuls tissue velocity (E'/A'). Samples for the measurement of TnT and troponin I (TnI) were taken just before hemodialysis and this measurement was repeated 3 weeks later. Patients with a mitral valvular disease, abnormal TnI (>0.1mg/l), or atrial fibrillation were excluded. Patients were classified into continuous TnT>0.1mg/l group (Group I, n=8) and the other group (Group II, n=43). Left ventricular systolic dysfunction (LVSD) was defined as a LVEF <45%. Patients with pseudonormal (E/A>1, E'<8.5cm/sec, and E'/A'<1) or restrictive diastolic filling pattern were considered to have a severe left ventricular diastolic dysfunction (LVDD). Result: TnT>0.1mg/l group has bigger LAD and LVEDV and higher prevalence of severe LVDD than TnT<0.1mg group. Severe LVDD, LVMI, LAD were independent correlates of TnT>0.1mg/l in a multiple logistic regression model including LVMI, LVSD, LAD, severe LVDD, ARD, and LVEDV. Conclusion: TnT elevation in CRF was associated with severe LVDD. High mortality in CRF with TnT elevation may be associated with severe LVDD.