Background and purpose Previous studies have shown that the role of global longitudinal 2DS in diagnosing and detecting coronary artery disease is modest. However, data on the sensitivity of the regional 2DS assessment is lacking (1–6). The aim of this study was to determine whether in echocardiographic evaluation of myocardial ischemia, regional 2D strain (2DS) assessment is more sensitive and specific in detecting ischemia due to critical stenosis of one or more coronary arteries in comparison with current standard of visual assessment of regional wall motion abnormalities (RWMA). Material and methods This retrospective study included 123 patients admitted through the Emergency Department across 36 months with the diagnosis of NSTE-ACS without previously known CAD or LBBB who underwent coronary angiography within the first 24 hours and had an echocardiogram with RWMA analysis done prior to procedure. 2DS analysis of regional longitudinal peak systolic strain (LPSS) according to the 18-segment model was performed by four clinicians, blinded to patient's clinical data. Results A significant correlation was found between individual parameters of LPSS and significant stenosis of all three major coronary vessels (>70% narrowing on coronary angiography, Table 1). Lower regional LPSS correlated well anatomically with the supplying arteries; for example, patients with LAD stenosis had significantly lower regional LPSS in all apical segments, lateral, anteroseptal and anterior mid segments and anterior basal segment. Similar patterns were seen in the LCx and RCA regions. Three graphs show the sensitivity and specificity of the most sensitive segments for each artery. The diagnostic accuracy of endocardial and epicardial regional LPSS was similar to the average regional LPSS. Conclusion We have shown that regional 2DS could be a good predictor of the presence and localization of coronary stenosis for each of the three main coronary arteries but further studies are needed to confirm this assumption. Funding Acknowledgement Type of funding sources: None.