AIMS: To determine if echocardiographic tissue Doppler imaging (TDI) performed at rest detects reduced myocardial function in patients with reversible ischaemia. METHODS AND RESULTS: Eighty-four patients with angina pectoris, no previous history of ischaemic heart disease and normal left ventricular ejection fraction were examined with colour TDI, single-photon emission computed tomography (SPECT), and coronary angiography (CAG). Patients with a normal SPECT (n= 42) constituted the control group and patients with a positive SPECT (n= 42) were divided into patients with (true-positive SPECT, n= 30) or without (false-positive SPECT, n= 12) significant coronary stenoses assessed by CAG. Regional longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured by colour TDI at six mitral annular sites and averaged to provide global estimates. In patients with reversible ischaemia both global systolic and diastolic function were impaired in terms of reduced average s' (5.6 ± 0.9 vs. 6.1 ± 1.1 cm/s; P<0.05), reduced average e' (5.9 ± 1.8 vs. 7.0 ± 1.7 cm/s; P<0.01) and increased average E/e' (14.2 ± 5.0 vs. 11.5 ± 3.9; P<0.01). This impairment of the cardiac function was even more evident in patients with a true-positive SPECT with reduced average s' (5.5 ± 0.8 vs. 6.1 ± 1.1 cm/s; P<0.01), reduced average e' (5.2 ± 1.5 vs. 7.0 ± 1.7 cm/s; P<0.001), and increased average E/e' (15.5 ± 5.2 vs. 11.5 ± 3.9; P<0.001), whereas no difference in myocardial velocities could be demonstrated in patients with a false-positive SPECT compared with controls. CONCLUSION: In patients with stable angina pectoris, preserved ejection fraction, and reversible ischaemia assessed by SPECT, echocardiographic colour TDI performed at rest reveals impaired cardiac function. The impairment of the cardiac function seems to be evident only in patients with a true-positive SPECT and colour TDI may therefore increase its diagnostic value.