Left bundle branch block (LBBB) increases the likelihood of developing reduced left ventricular (LV) ejection fraction (EF) but predicting which patients with LBBB and normal LVEF will develop decreased LVEF remains challenging. Fifty patients with LBBB and normal LVEF were retrospectively identified. Clinical, electrocardiographic (ECG), and echocardiographic variables were compared between patients who developed a decreased LVEF and those who did not. A total of 16/50 patients developed reduced LVEF after 4.3 (SD=2.8) years of follow-up. Baseline patient and ECG variables were similar between patients who did and did not develop decreased LVEF. Baseline LVEF was lower in patients who developed decreased LVEF than in those who did not [51.9% (SD=2.2%) vs. 54.9% (SD=4.4%), P<0.01.] Diastolic filling time (DFT) accounted for a significantly smaller percentage of the cardiac cycle in patients who developed decreased LVEF than in those who did not [35.9%, (SD=6.9%) vs. 44.4% (SD=4.5%) P<0.01]. In univariable logistic regression, DFT had a C-statistic of 0.86 (P<0.0001) for prediction of development of decreased LVEF. In conclusion, patients in whom DFT accounted for <38% of the cardiac cycle had a relative risk of developing decreased LVEF of 7.0 (95% CI 3.0-16.0) compared to patients with DFT accounting for ≥38% of the cardiac cycle.