The objective of this study was to determine whether diastolic dysfunction (DD) is associated with outcomes in the absence of myocardial ischemia. We studied 2,835 patients undergoing exercise echocardiography (ExEcho) from January 2006 through December 2006 who had normal systolic function (ejection fraction ≥50%) and absence of exercise-induced wall motion abnormalities. Diastolic function was graded as normal, mild DD, or moderate/severe DD. Medical record review and patient contact was undertaken to determine mortality, cardiovascular events (i.e., death, myocardial infarction (MI), or stroke), incident heart failure (HF) and hospitalization. Mean (SD) age was 58.9 (12.8) years; 54.0% were female. DD was present in 40.0% of participants; 28.2% had mild DD and 11.8% had moderate/severe DD. Over a median follow-up of 4.4 years there were 81 deaths and 114 cardiovascular events, and DD was associated with higher rates of mortality, cardiovascular events, and HF events or hospitalizations (all p<0.001). In multivariate analysis, mild or moderate/severe DD (referent; normal) was associated with HF or hospitalization (HR 1.45 (95% CI 1.18–1.78; p<0.001 for mild DD; HR 1.75 (95% CI 1.37–2.24; p<0.001 for moderate/severe DD) but was not independently associated with death or cardiovascular events. The diastolic index of filling pressure (E/e′) was independently associated with mortality, cardiovascular events, and HF or hospitalizations. In conclusion, among patients without demonstrable myocardial ischemia, left ventricular DD was associated with higher event rates over long-term follow up but did not independently predict hard endpoints other than HF or hospitalization. E/e′ was independently associated with clinical outcomes and may be an important echo-derived parameter to identify in patients undergoing ExEcho.