Left ventricular motion estimation is very important for diagnosing cardiac abnormality. One of the popular techniques, optical flow technique, promises useful results for motion quantification. However, optical flow technique often failed to provide smooth vector field due to the complexity of cardiac motion and the presence of speckle noise. This chapter proposed a new filtering technique, called quasi-Gaussian discrete cosine transform (QGDCT)-based filter, to enhance the optical flow field for myocardial motion estimation. Even though Gaussian filter and DCT concept have been implemented in other previous researches, this filter introduces a different approach of Gaussian filter model based on high frequency properties of cosine function. The QGDCT is a customized quasi discrete Gaussian filter in which its coefficients are derived from a selected two-dimensional DCT. This filter was implemented before and after the computation of optical flow to reduce the speckle noise and to improve the flow field smoothness, respectively. The algorithm was first validated on synthetic echocardiography image that simulates a contracting myocardium motion. Subsequently, this method was also implemented on clinical echocardiography images. To evaluate the performance of the technique, several quantitative measurements such as magnitude error, angular error, and standard error of measurement are computed and analyzed. The final motion estimation results were in good agreement with the physician manual interpretation.