Speckle tracking two-dimensional (2D) strain echocardiography is a novel and promising technique with multiple emerging clinical applicabilities.1,2 In most patients, the method is easy to perform during routine transthoracic echocardiography by the acquisition of the regular 2D gray-scale images, which can then be evaluated offline by the use of work stations. Strain echocardiography has been demonstrated to be useful for assessing and monitoring left ventricular (LV) systolic function in several cardiac disease entities. A major advantage of speckle tracking echocardiography is its angle-independency in comparison with tissue Doppler (TDI) which enables regional and global analysis of myocardial velocities and deformation parameters such as strain or strain rate by the use of an image-processing algorithm of the grey scale pixels. In principle, strain measures the myocardial fibre contraction magnitude, and therefore may detect subtle subclinical LV dysfunction in an early stage. LV function presents a well-established prognostic factor strongly influencing outcome in valve disease and is included in the EuroSCORE preoperative risk calculation for cardiac surgery.3 However, the echocardiographic assessment of the LV ejection fraction (EF) faces several major limitations, including load dependency and imaging quality for endocardial border delineation.1 Importantly, it has been repeatedly observed, that despite apparently preserved ‘normal’ LV EF, myocardial contractility may already be reduced, reflected by impaired longitudinal 2D strain.1,2. In the setting of severe mitral regurgitation, compensatory LV dilatation and geometry changes may sustain a normal stroke volume at rest, although myocardial contractile reserve may already deteriorate even in asymptomatic patients. Therefore, careful assessment of the LV function including longitudinal strain in …