In clinical situation, left ventricular (LV) function especially systolic function is generally assessed by measuring the extent and velocity of fiber shortening i.e., ejection fraction (EF) and fractional shortening (FS). Ejection fraction is commonly measured by echocardiography, in which the volumes of chambers are measured during the cardiac cycle. Sometimes the evaluation of LV function in the patients with left ventricular hypertrophy (LVH) is problematic. Although their LV function is almost always normal or supernormal, the prognosis of patients with LVH is poorer than normal subjects. The possible reason is that conventional EF or FS measured at endocardial surface may not accurately reflect the contractile behavior of myocardial fiber across the wall. Therefore, many researchers have recommended to use the midwall instead of the endocardium when the ventricular function of LVH was assessed. In the present article, all that midwall will be reviewed.