Speckle tracking echocardiography using average global strain and strain rate (SR) parameters for early detection of high risk patients with coronary artery disease (CAD) has gained a substantial clinical interest. Objective: Assessment of the diagnostic accuracy of strain imaging of the left ventricle in detection of obstructive coronary artery disease. Methods: One hundred patients were enrolled. They were divided into 3 groups: Group I (n = 40 patients) presented with ST segment elevation

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... cardial infarction (STEMI), Group II (n = 40 patients) presented with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and Group III (n = 20 patients) with normal coronary angiography served as a control group. All patients were subjected to 2D speckle tracking echocardiography (2D STE) to assess LV longitudinal strain and strain rate (SR). Sensitivity, specificity and diagnostic accuracy of 2D STE in prediction of CAD and its severity using Gensini score were assessed. Results: The mean age for Group I, II and III was 52.20 ± 11.83, 51.97 ± 14.53 and 52.75 ± 10.75 respectively. LV average global systolic strain (AGS) was significantly lower in group I and II when compared to group III. AGS and average global systolic SR showed significant direct correlation with Gensini score. The diagnostic accuracy of 2D STE in prediction of significant LAD stenosis was 92.5%, and it was 89.5% in prediction of 3 vessels CAD. Conclusion: Strain imaging using 2D STE can predict the territory and severity of CAD with high diagnostic accuracy and can be used as a simple noninvasive diagnostic tool to identify high risk CAD patients.