Background Tissue Doppler imaging of systolic mitral annular velocity (Sm) has been shown to be able to detect early left ventricular (LV) dysfunction in the presence of chronic severe mitral regurgitation with normal left ventricular ejection fraction. We investigated the association of preoperative Sm with LV reverse remodeling after mitral valve surgery. Methods Patients with chronic severe organic mitral regurgitation exhibiting LV ejection fraction greater than 60% were enrolled. The LV reverse remodeling was defined as changes of LV mass index of 20% or greater postoperatively. The primary endpoints were to compare the changes of LV mass index in relation to the tertile distribution of the Sm and evaluate predictive value of the Sm for LV reverse remodeling. Results In all, 169 patients were analyzed. The changes of LV mass index in the first tertile was 25% (11% to 37) compared with 34% (19% to 43%) in the second tertile and 34% (26% to 47%) in the third tertile (p = 0.003). On multivariate analysis, Sm was the only independent predictor of LV reverse remodeling (odds ratio 1.77, 95% confidence interval: 1.30 to 2.40, p < 0.001). The optimal cutoff value measured by receiver-operating characteristic curve analysis was 7 cm/s of Sm (area under the curve 0.721, 95% confidence interval: 0.64 to 0.80, p < 0.001). Conclusions In patients with severe mitral regurgitation exhibiting LV ejection fraction greater than 60%, surgery may be considered before the Sm is decreased below 7 cm/s to achieve favorable LV reverse remodeling.