BackgroundTo evaluate subtle and early premature ventricular complex (PVC)–induced ventricular impairment in patients with frequent PVCs and without structural heart disease by real‐time 3‐dimensional (3D) speckle tracking echocardiography (RT3D‐STE).HypothesisPatients with frequent premature ventricular complexes with normal left ventricular ejection fraction have subtle left ventricular dysfunction.MethodsForty patients (22 male) with a single source of frequent PVCs and 40 healthy controls (24 male) underwent assessment by conventional 2‐dimensional (2D) echocardiography and RT3D‐STE. Left ventricular ejection fraction (LVEF), and global longitudinal, circumferential, radial, and area strain (GLS, GCS, GRS, and GAS, respectively) and individual segment strain were calculated using off‐line analysis software and compared between the 2 groups.ResultsThere were no significant differences in baseline clinical or 2D echocardiographic variables including LVEF between groups. However, all RT3D‐STE assessed variables, including GLS, GCS, GRS, GAS, and individual segment strain, were significantly lower (P < 0.05) in the PVC group than the control group, and showed strong correlations, most prominently GCS (r = −0.84, P = 0.020), with LV function as assessed by LVEF. 3D‐STE measurements showed good intraobserver, interobserver, and test–retest agreement.ConclusionsIn patients with frequent PVCs and normal LVEF, 3D ‐STE revealed lower global and regional strain values than in healthy controls. RT3D‐STE is a novel, feasible and reproducible method to assess cardiac function and appears suitable to detect subtle left ventricular dysfunction.