Description: Aims Contradicting reports have been published regarding the relation between a dobutamine-induced increase in either cardiac dyssynchrony or left-ventricular ejection fraction (LVEF) and the response to cardiac resynchronization therapy (CRT). Using apical rocking (ApRock) as surrogate dyssynchrony parameter, we investigated the dobutamine stress echocardiography (DSE)-induced changes in left-ventricular (LV) dyssynchrony and LVEF and their potential pathophysiological interdependence. Methods and results Fifty-eight guideline-selected CRT candidates were prospectively enrolled for low-dose DSE. Dyssynchrony was quantified by the amplitude of ApRock. An LVEF increase during stress of 〉5% was regarded significant. Scar burden was assessed by magnetic resonance imaging. Mean follow-up after CRT implantation was 41 ± 13 months for the occurrence of cardiac death. ApRock during DSE predicted CRT response (AUC 0.88, 95% CI 0.77–0.99, P 〈 0.001) and correlated inversely with changes in EF ( r = –0.6, P 〈 0.001). Left-ventricular ejection fraction changes during DSE were not associated with CRT response ( P = 0.082). Linear regression analysis revealed an inverse association of LVEF changes during DSE with both, total scar burden (B = –2.67, 95CI –3.77 to –1.56, P 〈 0.001) and the DSE-induced change in ApRock amplitude (B = –1.23, 95% CI –1.53 to –0.94, P 〈 0.001). Kaplan–Meier analysis revealed that DSE-induced increase in ApRock, but not LVEF, was associated with improved long-term survival. Conclusion During low-dose DSE in CRT candidates with baseline dyssynchrony, myocardial contractile reserve predominantly results in more dyssynchrony, but less in an increase in LVEF. Dyssynchrony at baseline and its dobutamine-induced changes are predictive of both response and long-term survival following CRT.