Background: To examine the value of speckle tracking echocardiography to detect the presence, extent and severity of coronary artery affection in patients with suspected stable angina pectoris. Methods: Two hundred candidates with suspected stable angina pectoris and normal resting conventional echocardiography were subjected to speckle tracking echocardiography and coronary angiography. Global and segmental longitudinal peak systolic strain were assessed and were correlated to the results of coronary angiography for each patient. Results: There was a statistically significant difference in the mean of global longitudinal peak systolic strain between normal coronaries and different degrees of coronary artery disease (CAD) (
20.11 0.8 for normal,
18.34  2.52 for single vessel,
16.14  2.85 for two vessels,
14.81  2.12 for three vessels,
13.01  2.92 for left main disease). GLPSS showed high sensitivity for the diagnosis of single vessel CAD (90%, specificity 95.1%, cutoff value:
18.44, AUC: 0.954); two vessels disease (90%, sensitivity 88.9%, cutoff value
17.35, AUC: 0.906) and for three vessels CAD (cutoff value
15.33, sensitivity 63% and specificity 72.2% AUC 0.681) segmental LPSS also showed statistical significance for localization of the affected vessel for left anterior descending, left circumflex and right coronary artery (r = 0.001) and inverse correlation with syntax score that was significant with high and intermediate score (r = 0.001) and insignificant for low syntax score (r value 0.05). Conclusion: Two-dimensional speckle tracking echocardiography has good sensitivity and specificity to predict the presence, extent and severity of CAD. © 2017 Published by Elsevier B.V. on behalf of Cardiological Society of India. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).