Aim To determine how the left ventricular wall motion assessed by echocardiographic Tissue Doppler Imaging (TDI) is affected by increasing severity of coronary artery disease (CAD) among patients with stable angina pectoris and preserved ejection fraction. METHODS AND RESULTS: This study comprises 82 patients with suspected angina pectoris, no previous cardiac history, and a normal ejection fraction, who were all examined with colour TDI prior to coronary angiography. Patients without significant stenoses (n = 35) constituted the control group and patients with significant stenoses (n = 47) were divided into three groups according to significant one-, two-, or three-vessel disease (n = 18, n = 14, and n = 15, respectively). Regional longitudinal peak systolic (s'), early (e'), and late diastolic (a') myocardial velocities were measured at six mitral annular sites and averaged to provide global estimates. Each patient with significant coronary disease was matched with a control of the same age, sex, body mass index, and status regarding diabetes and hypertension. Global systolic and diastolic performance by TDI (in terms of global s' and E/e') were negatively correlated to the number of vessels with significant stenoses (both P <0.05). Regional analyses revealed that in one- and two-vessel disease, e' decreased significantly in the segments supplied by a stenotic artery. In patients with one-vessel disease, a' increased compensatorily with a significant reduction of e'/a'-ratio (0.86 +/- 0.24 vs. 1.00 +/- 0.28, P <0.05). Both regional and global s' was significantly reduced in patients with three-vessels disease. CONCLUSION: Colour TDI performed at rest in patients with stable angina and preserved ejection fraction reveals both diastolic and systolic dysfunction and the nature of the dysfunction depends on the extent of the CAD.