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To determine whether systolic or diastolic dysfunction on transthoracic echocardiogram (TTE) predicts mortality after out-of-hospital cardiac arrest (OHCA).Retrospective cohort study of 173 OHCA subjects undergoing targeted temperature management who underwent TTE during hospitalization. Univariate analysis and multivariate logistic regression were used to determine associations between TTE measurements of systolic and diastolic function and systemic hemodynamics with all-cause mortality.Mean age was 61.6 ± 12.4 years (72.7% male) and initial rhythm was shockable in 89%. Hospital mortality was 30.6%. Mean LVEF was 40% and was not different in hospital survivors (p = 0.81). TTE parameters reflecting systolic function and systemic hemodynamics did not predict hospital mortality. Medial mitral E/e′ ratio was associated with hospital mortality, with an optimal cut-off > 13 (p = 0.002). After multivariate adjustment, medial mitral E/e′ ratio remained predictive of hospital mortality (OR 1.11, 95% CI 1.03–1.20, p = 0.004). Subjects with a medial mitral E/e′ ratio > 13 had higher mortality during long-term follow-up (p < 0.001 by log-rank).Diastolic dysfunction (higher medial mitral E/e′ ratio) on TTE independently predicted mortality after OHCA; systolic dysfunction and TTE hemodynamic parameters did not. This reflects a novel use of Doppler TTE to predict outcomes after OHCA.Left ventricular ejection fraction did not predict mortality after cardiac arrest.Systemic hemodynamics by echocardiography was not associated with mortality.Diastolic dysfunction (higher mitral E/e′ ratio) predicted hospital mortality.Diastolic dysfunction predicted long-term mortality after multivariate adjustment.Mitral E/e′ ratio > 13 is associated with higher mortality after cardiac arrest.