Abstract: AIM To assess the clinical value of real-time three-dimensional echocardiolography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI) in evaluating left ventricular (LV) global systolic function and synchrony in patients with myocardial ischemia and myocardial infarction and to investigate the correlation of the two techniques in left ventricular synchrony. METHODS RT-3DE and 2D-STI were performed in 46 patients with myocardial ischemia, 44 patients with myocardial infarction and 60 healthy subjects (control group). Offline analysis was conducted using Qlab 8.1 to measure or calculate the parameters of systolic function (GLS, GCS, GRS, 3D-LVEDV, 3D-LVESV, 3D-LVEF) and synchrony (Tls-l6-SD, Trs-l2-SD, Tcs-l2-SD, TAS-POST, Tmsv-l6-SD, Tmsv-16-Dif). RESULTS Compared with those in the control group, no positive manifestations were found using conventional echocardiography in myocardial ischemia group. GLS significantly decreased, Tls-16-SD was significantly prolonged measured by 2D-STI (P<0.05), Tmsv-16-SD and Tmsv-16-Dif significantly increased measured by RT-3DE (P<0.05) and left ventricle regional abnormal wall motion was displayed in the bull’s-eye map of RT-3DE. Compared with those in the myocardial ischemia group and control group, conventional echocardiography, 2D-STI and RT-3DE, respectively, had positive manifestations in myocardial infarction group. Tmsv-16-SD and TAS-POST were positively correlated (r=0.574, P<0.01) but no correlation was found in other synchrony parameters. CONCLUSION 2D-STI and RT-3DE can early assess LV systolic synchrony in patients with myocardial ischemia. Tmsv-16-SD and TAS-POST are positively correlated.