Echocardiographic strain imaging, known as deformation imaging, has been developed as a means to objectively quantify regional and global myocardial function. Strain can be obtained with tissue Doppler imaging or with 2D speckle tracking. Strain imaging has been used to gain greater understanding into the pathophysiology of ischemic heart disease, dyssynchrony, cardiomyopathies, the effects of valvular disease on myocardial function even at the subclinical stage, and diastolic heart failure. Strain imaging has also been used for the evaluation of cardiotoxicity to detect left ventricular (LV) dysfunction prior to fall in LV ejection fraction in patients undergoing chemotherapy. Strain imaging can be used to assess right ventricular and left atrial function. Further advances, such as 3D speckle tracking strain imaging, have emerged to provide even greater insight. Strain imaging is still undergoing development, and further clinical studies are required to determine if clinical decisions based on strain imaging result in better outcomes. With this important limitation in mind, strain may have great potential to play many roles in clinical practice.