Peripheral arterial disease (PAD) diagnosed by ankle-brachial index (ABI) evaluation is associated with a high cardiovascular mortality rate. Transthoracic echocardiography (TTE) allows identification of left ventricular (LV) dysfunction and other cardiac findings associated with an increased cardiovascular mortality rate, for which treatments to alter prognosis are available. We sought to determine the prevalence of important TTE abnormalities in outpatients with symptomatic PAD by performing screening TEE. Outpatients without previous echocardiography who had been referred for ABI evaluation for suspected PAD underwent prospective screening TTE. The primary end points were LV dysfunction (LV ejection fraction <or=54%) and the composite of any clinically important echocardiographic finding. Patients confirmed to have PAD (ABI <or=0.9, n = 120) were found to have a high prevalence of LV dysfunction (26.7%), marked LV dysfunction (LV ejection fraction <45%) (14.2%), aortic stenosis (5.0%), and composite of any clinically important finding (36.7%). Patients with PAD had significantly more LV dysfunction and composite clinically important findings than patients without PAD (ABI >0.9, n = 84), and PAD was found to be an independent predictor of LV dysfunction (odds ratio 2.8, 95% confidence interval 1.2 to 6.4) and composite clinically important echocardiographic findings (3.2 95% confidence interval 1.5 to 7.1, p <0.01). In conclusion, outpatients with symptomatic PAD have a high prevalence of clinically important TTE abnormalities, including LV dysfunction, and PAD is an independent predictor of an abnormal echocardiogram.