Doppler tissue imaging (DTI) is a new noninvasive imaging modality that directly interrogates myocardial velocity with high temporal and spatial resolution. This study was designed to test the hypothesis that quantitative DTI provides unique information regarding regional myocardial systolic and diastolic function during acute ischemic events. Myocardial velocities were quantified during the acute ischemic and reperfusion phases of 13 elective percutaneous coronary angioplasty procedures in 12 patients. In myocardium subtended by angioplasty vessels, peak velocities decreased during occlusive balloon inflation (from 21.2 ± 9.8 to −0.6 ± 4.0 mm/sec in systole [p < 0.001] and from 21.7 ± 9.2 to −0.6 ± 3.9 mm/sec in diastole [p < 0.001]). During early reperfusion, velocities exceeded those observed at baseline (p = 0.003). In regions remote from the treated artery, peak myocardial velocities increased in the absence of significant stenosis but remained unchanged or decreased in the presence of significant stenosis of the associated vessel. We conclude that (1) myocardial velocities rapidly decrease during acute ischemia and show a rebound increase after reperfusion, and (2) in regions remote from ischemia, velocities display distinct patterns on the basis of the presence or absence of obstructive coronary disease in the associated vessel. Quantitative DTI is a useful tool for the assessment of myocardial velocity and may provide new insights into myocardial systolic and diastolic function.