To determine whether mitral valve annulus displacement (MVAD) can be used to assess septal contractility in patients with paradoxical septal motion, we assessed four atrioventricular regions (septum, lateral wall, anterior wall, and inferior wall) by MVAD in 80 consecutive patients. The patients were divided into five groups: group 1 (control) (n = 20), normal left ventricular (LV) systolic function; group 2 (n = 15), paradoxical septal motion resulting from left bundle branch block (LBBB) and normal segmental and global LV systolic function; group 3 (n = 19), paradoxical septal motion as a result of cardiac surgery, and normal segmental and global LV systolic function; group 4 (n = 11), paradoxical septal motion resulting from LBBB, dilated cardiomyopathy, and severely depressed LV systolic function; group 5 (n = 15), septal hypokinesis with either normal or mildly depressed global LV systolic function. In groups 1, 2, and 3, 80% to 100% of patients had septal and other regional MVAD ≥ 1.0 cm. The average MVAD in group 4 (dilated cardiomyopathy), was significantly decreased (≤0.8 cm), in all four regions (p < 0.01 compared with groups 1,2, and 3). In group 5 (septal hypokinesis), the septal MVAD was ≥ 1.0 cm in only 13% of the patients (p < 0.025 compared with groups 1,2, and 3). In conclusion, patients with paradoxical septal motion caused by LBBB or cardiac surgery have preserved septal contractility when evaluated by MVAD.