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Background: Although being considered a robust measure of left ventricular (LV) systolic function, global longitudinal 2D strain (LS) had weak correlations with LVEF in ischemic heart disease. We studied the relationship of 3D strain parameters with 3D LVEF and their predictive value for identifying LV dysfunction (i.e. LVEF<55%).Methods and results: 40 pts with documented coronary artery disease (age 60±14, 31 men, 3D LVEF=50±13%, range 19-69%) underwent 3D echo with Vivid E9 (GE, Horten, N). Global peak values of LS, circumferential (CS), radial (RS) and area strain (AS) were computed with EchoPac BT 11 in 38 pts (23 had LVEF <55%). All 3D strains were closely correlated with EF (r=-0.88 for AS, r=-0.86 for LS, CS, r=0.86 for RS, p<0.001 for all). All strains had an excellent accuracy to identify a LVEF <55% (Table 1, Figure 1).Conclusions: In ischemic pts with wide range of LVEF, all 3D strain indexes showed a close correlation with LVEF and a good predictive power to identify LV dysfunction. Global CS had the best discriminative power to identify a 3D LVEF<55%. These findings probably reflect the ability of 3D speckle-tracking to fully capture the complex LV deformation in ischemic heart disease.