Theuseofspeckle-trackingechocardiography(STE)isbecominganincreasinglyusefultoolintheevaluationofmyocardialdisease.STEsoftwarecantrackthemotionofthespecularpatterncreatedbytheinterferenceofultrasoundwiththemyofibersoftheheartandprovideaquantitativemeanstoevaluatesubtlechangesinventricularfunctionthatoftenoccurbeforechangesinventricularejectionfractionareobserved.STEismostoftenusedtomeasurethechangeinshape(strain)ofmyocardialsegmentsinthecircumferential,radial,andlongitudinaldirections.Invariousdiseases,includingcoronaryarterydisease,aorticstenosis,andmitralregurgitation,deficitsinlongitudinalstrainappeartooccurearlierthandeficitsinothermeasuresofstrainorinejectionfraction.ConsiderationofSTEmeasuresofleftventricularcontractionhasthepotentialtosignificantlyaffectclinicalmanagementandoutcomesofischemicandvalvularheartdiseasegiventheabilitytoseparatethosewithasymptomaticdiseasewhomaybenefitfromearlierinterventionsthancurrentguidelinesmaysuggest.