Background: Decrease of left atrial appendage (LAA) emptying flow velocity has been considered as LAA dysfunction. Tissue Doppler Velocity (TDV) could be applied to LAA for regional function. Thus, we tried to assess the characteristics of TDV and flow velocity of LAA in the patients with first and recurrent stroke. Methods: A total of 63 patients were included. The optimal imaging of LAA was obtained in the mid-esophageal view with the imaging sector of 90째. The LAA flow and TDV were obtained (Triphasic pattern: initial upward/Emptying/Filling pattern) from medial and lateral side-wall of LAA by transeshophageal echocardiography. The event for recurrent stroke was observed for follow up duration. Results: During a follow up duration (mean 332 days), 4 patients experienced a recurrent stroke. In the patients with recurrent stroke, LA volume was much enlarged (p=0.044). Both emptying and filling-TDV of medial side LAA (p=0.076, p<0.001 respectively) showed a trend toward lower velocity, whereas there were no differences in terms of flow velocity and lateral side-TDV of LAA. On the multivariate analysis, the emptying TDV of medial side LAA had a marginal power for a risk for recurrent stroke (Hazard ratio, 0.51; p=0.054). Conclusion: In terms of LAA dysfunction, the recurrent stroke patients showed the decrease of TDV in medial side LAA, which might appear to be a clinically applicable and informative assessment of regional LAA function.