Objective To assess left ventricular (LV) geometry, LV diastolic and systolic function in maintenance hemodialysis uremic patients. Methods Forty uremic patients and forty-five normal subjects were included in this study. LV volume, LV mass index (LVMI), relative wall thickness (RWT), LV mass and diastolic volume ratio (LVM/EDV) were measured. Mitred flow E velocity and A velocity ratio, deceleration time, mitral flow E velocity and mitral annulus Ea velocity ratio (E/Ea), pulmonary vein flow S velocity and D velocity ratio, atrial flow reversal velocity of pulmonary vein flow, mitral inflow propagation velocity, left atrium volume (LAV) and pulmonary artery systolic pressure (PASP) were determined for diastolic function evaluation. LV ejection fraction (LVEF) and single volume (SV) were derived from 3D echocardiography, systolic velocity of mitral valve annulus (Sa) by pulse tissue Doppler imaging (TDI) were used to evaluate systolic function. The time to peak systohc velocity (Ts) and early diastole velocity (Td) of LV 12 segments were measured using TDI. The maximal difference of Ts and Td (Ts-Dif and Td-Dif) were calculated to assess LV systolic and diastolic asynchrony. Results RWT, LVMI and LVM/EDV were significantly increased in uremic patients. There were 50% concentric, 17. 5% eccentric hypertrophy and 17. 5% concentric remodeling, respectively in uremic patients. The indices for LV diastolic function (E/ Ea, LAV and PASP) were significantly higher in uremic patients than those in control subjects (P<0.01). About 85% of the diastolic dysfunction in uremic patients presented as impaired relaxation pattern and 32. 5% as increased filling pressure. LVEF and SV were similar between uremic patients and control subjects. Sa was significantly lower in uremic group than that in controls (P<0.05). Ts-Dif was similar between the 2 groups while Td-Dif was significantly higher in uremic patients than control subjects (P< 0.05). Conclusion LV hypertrophy, LV mass increase and LV diastolic dysfunction were the major characteristic of myocardial injury in uremia patients.