Objective To explore the application value of tissue Doppler imaging (TDI) and spatiotemporal image correlation (STIC) in evaluating left heart function in fetuses with different severity of preeclampsia (PE). Methods A retrospective analysis was performed on the clinical diagnosis and treatment data of 88 pregnant women with PE confirmed in the hospital between June 2020 and June 2023. According to disease severity, they were divided into mild preeclampsia group (MPE group, n=58) and severe preeclampsia group (SPE group, n=30). A total of 50 normal pregnant women during the same period were enrolled as control group. All the research objects underwent TDI and STIC to examine left heart function. The parameters related to TDI [peak early diastolic velocity (Em) of atrioventricular valves (mitral valve, tricuspid valve), peak end diastolic velocity (Am), Em/Am, peak systolic velocity (Sm), myocardial performance (Tei) index] and STIC [left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left ventricular stroke volume (LVSV), left ventricular cardiac output (LVCO)] in the three groups were compared. All pregnant women were followed up till delivery. According to echocardiographic screening results, 88 neonates were divided into congenital heart disease (CHD) group and non-CHD group, Tei index and LVEF in the two groups were compared. The screening value of TDI, STIC and combined detection for CHD was analyzed by ROC curves. Results There were significant differences in TDI and STIC parameters among the three groups (P<0.05). Em of mitral and tricuspid valves, Em/Am, Sm, LVEF, LVSV and LVCO in SPE group were lower than those in MPE group and control group, while Am, Tei index, LVEDV and LVESV were higher than those in MPE group and control group (P<0.05). After follow-up, echocardiographic results showed that in the 88 neonates, there were 12 cases (13.64%) in CHD group and 76 cases (86.36%) in non-CHD group. In CHD, there were 9 cases (75.00%) in SPE group, 3 cases (25.00%) in MPE group and 0 case (0.00%) in control group, the difference among the three groups was statistically significant (P<0.05). Tei index in CHD group was higher than that in non-CHD group, while LVEF was lower than that in non-CHD group (P<0.05). The results of ROC curves analysis showed that sensitivity and specificity of TDI combined with STIC for screening CHD were higher than that of single detection (P<0.05). Conclusion TDI and STIC can be applied to evaluate fetal left heart function in pregnant women with PE. The changes of TDI and STIC related parameters indicate decline of fetal left heart function. TDI and STIC have high sensitivity and specificity for screening CHD children, and the value of combined detection is higher.