Background: Coronary artery ectasia (CAE), known as a dilatation of coronary segment to at least 150% of the diameter of adjacent healthy segment. Despite the fact that coronary ectasia is under-treated angiographic finding, it has a tremendous impact on patients mortality and morbidity. The hypothesis that isolated CAE is a cause of subtle left ventricle (LV) systolic dysfunction needs intense and thorough research. Objective: To assess longitudinal LV functions in patients with isolated coronary ectasia using 2 dimensional (2D) speckle tracking echocardiography. Patients and Methods: This study is a case control study conducted on two groups of patients referred to our tertiary centre for elective coronary angiography. The first group included 30 consecutive symptomatic patients proved to have CAE without obstructive coronary artery disease. The second group included 30 patients with normal coronary angiography serving as a control group. Patients with any form of structural heart disease affecting LV systolic functions were excluded, echocardiographic evaluation was held for every patient targeting 2D assessment of systolic and diastolic functions, tissue Doppler measurements and finally offline 2D speckle tracking for assessment of global LV longitudinal strain. Results: Males were more dominant in CAE group. Hypertension and dyslipidemia were more prevalent in CAE group unlike diabetes that was more common among control subjects. LV volumes, dimensions, mass index, left atrium (LA) volume index and aortic root diameter were significantly higher among CAE group. Mean global longitudinal strain was significantly lower in CAE group with value of (-16.5%) versus (-19.5%) in control group. Conclusions: Global longitudinal strain is significantly reduced in patients with CAE even in the absence of obstructive coronary artery disease denoting subclinical LV systolic dysfunction.