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Myocardial strain imaging has gained popularity during the last decade in various clinical scenarios. The objective of this article was to review the potential application of two-dimensional (2D) and three-dimensional (3D) strains in patients with coronary artery disease.Reports on the diagnostic accuracy of myocardial deformation analysis using 2D and 3D speckle-tracking analyses to detect significant coronary stenosis at rest or during stress and to evaluate myocardial viability are limited. A newer 2D strain approach that uses layer-specific strain analysis might be sensitive in the detection of subtle regional myocardial dysfunction induced by myocardial ischemia. However, its potential accuracy is controversial. The regional assessment of wall motion by 2D/3D strain is not recommended because of measurement variabilities.Further studies are required for the adoption of this technology in patients with coronary artery disease.