We aimed to compare the effects of new treatment modalities to conventional hormone replacement therapy (HRT) on left ventricular (LV) diastolic function, by means of conventional and tissue Doppler echocardiography and the myocardial integrated backscatter (IBS) in postmenopausal women. One hundred and fifty healthy postmenopausal women were included in this study. Subjects were assigned to one of the five groups receiving 1 year of treatment (estrogen, estrogen plus progesterone, raloxifene, tibolone or placebo). E and A wave velocity, E/A ratio, isovolumic relaxation time (IVRT), deceleration time (DT), peak early (Em) diastolic mitral annular velocity, E/Em ratio, the cyclic variation of integrated backscatter (CVIBS) and the mean value of the IBS signal (MIBS) were determined before and 12 months after therapy. E (76 +/- 10 vs. 98 +/- 8 cm/s, P = 0.0001 and 78 +/- 10 vs. 90 +/- 12 cm/s, P = 0.02, respectively), Em (14.3 +/- 2.4 vs. 16.4 +/- 2.5 cm/s, P = 0.001 and 15.1 +/- 3.4 vs. 16.2 +/- 3.5 cm/s, P = 0.01, respectively), and E/A ratio (1.15 +/- 0.3 vs. 1.42 +/- 0.4, P = 0.0001 and 1.0 +/- 0.2 vs. 1.22 +/- 0.2, P = 0.01, respectively) were increased significantly compared to pretreatment in both estrogen and raloxifene groups while DT, A, E/Em, and IVRT were significantly decreased. A significant increase in CVIBS and decrease in MIBS were detected 12 months after estrogen and raloxifene administration while no significant changes were observed in other groups. Changes in the MIBS and CVIBS were found to be independently associated with the observed changes in the diastolic function indexes during therapy. Both estrogen and raloxifene regimens may improve LV diastolic functions in healthy postmenopausal women. This improvement may be a result of direct cardiac effects on LV myocardium.