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Background: Three-dimensional (3D) speckle tracking echocardiographic imaging (STI) is a new technique to evaluate left ventricular (LV) deformation by measuring the area strain (AS) of endocardial surface. This is a theoretical advantage that combines information from both longitudinal (LS) and circumferential strain (CS). We sought to assess AS in patients with systolic heart failure (SHF) using 3D-STI.Method: 19 SHF patients (age, 64.1±9.4 years) and 20 normal subjects with good image quality were recruited. 3D echocardiography was performed with full volume in an Artida ultrasound system (Toshiba Medical Systems, Japan). AS was measured as endocardial area change ratio during systole. 3D-dervied LV volumes and ejection fraction (EF), radial strain (RS), CS, and LS were also obtained.Result: LVEF measured by 3D echocardiography was markedly decreased in SHF (SHF vs. normal: 34±10% vs. 66±8%, p<0.001). 3D-STI analysis showed that all the strain values were significantly lower in SHF patients than normal controls (Table). However, among SHF patients, the AS had the strongest correlation with LVEF (r=0.94, p<0.001) as compared to other strain components (CS: r=0.86, p<0.001; LS: r=0.53, p<0.02; RS: r=0.54, p<0.02).Conclusions: Measurement of endocardial surface AS by 3D-STI is feasible. Compared to conventional 2D strain parameters, AS appears to be more closely related to the global LV systolic function in patients with SHF.