Objective To study the value of echocardiography-guided pacemaker parameters optimization in enhancing the efficacy of cardiac resynchronization therapy (CRT). Methods Thirty patients with chronic heart failure received biventricular resynchronous pacing therapy. An optimization procedure was performed with different AV and VV delays. Results The indices of heart function were significantly improved after CRT optimization. Left ventricular filling time (LVFT) was increased, mitral reflux (MR) was decreased, standard deviation of time to regional peak systolic velocity (Ts-12SD) was decreased, left ventricular outflow tract velocity time integral (VTILVOT) was increased, and the end of the left ventricular systolic volume (LVESV) was decreased. Conclusions Echocardiography-guided optimization of AV and VV delay can enhance the efficacy of CRT.