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Purpose: Left ventricular midwall fractional shortening (FS) has been used as a more physiologically appropriate measurement of left ventricular systolic performance in patients with left ventricular hypertrophy than conventional FS. On the other hand, 2-dimentional echocardiography is more accurate for evaluating left ventricular volume and ejection fraction (EF) compared with M-mode echocardiography. The purpose of this study was to assess the usefulness of midwall EF using 2-dimentional speckle tracking echocardiography.Method: Forty six patients with or without left ventricular hypertrophy were enrolled in this study. Left ventricular systolic function was assessed by EF, midwall FS and midwall EF. Relationship between these parameters and left ventricular mass index (LVMI) were investigated in this study. We also investigated the correlation between midwall EF and conventional tissue Doppler index.Results: The EF did not correlate with LVMI (r=0.173, p =NS). There was significant correlation between midwall EF and LVMI (r=0.748, p <0.0001). There was also significant correlation between midwall FS and LVMI (r=0.692, p <0.0001). The early systolic mitral annular velocity and the early diastolic mitral annular velocity correlated with LVMI (r=0.446, p =0.0019, r=0.418, p =0.0038, respectively). Midwall EF correlated with the early systolic mitral annular velocity and the early diastolic mitral annular velocity (r=0.418, p =0.0039, r=0.430, p =0.0028, respectively).Conclusion: Midwall EF correlates with the degree of left ventricular hypertrophy. Midwall EF can detect the left ventricular systolic dysfunction which cannot detect by conventional EF. Assessment of midwall EF may apply to assessment of left ventricular systolic performance in patients with various left ventricular geometry.