The aim of this study was to observe the effect of tissue Doppler on cardiac resynchronization therapy (CRT) in patients with chronic congestive heart failure (CHF). CRT was guided by tissue Doppler. Patients with CHF were studied by using tissue Doppler before and after resynchronization. The target vein was determined according to the latest systolic area identified via pre-implant tissue Doppler. After implantation, atrioventricular and interventricular intervals were optimized with the aid of tissue Doppler. Six months after CRT, a significant reduction in left ventricular end-diastolic dimension (6.89 ± 0.38 cm versus 6.45 ± 0.79 cm) and a significant increase in left ventricular ejection fraction (29% ± 2.19% versus 44.8% ± 8.47%) were observed. Simultaneously, intra-ventricular and inter-ventricular asynchrony indexes were significantly reduced. CRT guided by tissue Doppler can result in beneficial therapeutic effects.