Cardiac Resynchronisation Therapy (CRT) has been used extensively over the last years in the therapeutic management of the patients with end stage heart failure based on the data of large randomized trials on CRT. CRT improves symptoms, exercise capacity, quality of life and echocardiographic indices of severe systolic heart failure besides reduction in heart failure related hospitalizations and improvement in survival. However, there may be some non-responders as well. There is on-going research, which will identify patients without conventional indications for CRT so as to improve the responder rate. Tissue Doppler Imaging (TDI) techniques will assume an important role in identifying patients for CRT.