Background: Premature ventricular contractions have been described in 1% of clinically normal people as detected by standard ECG and 40–75% of apparently healthy persons as detected by 24–48 hour ambulatory ECG recording (Holter). In the absence of structural heart diseases, it is thought to be relatively benign. However, PVC-induced cardiomyopathy has been a subject of great interest over the last decade. Objective: To evaluate subtle and early premature ventricular complex (PVC)–induced ventricular impairment in patients with frequent PVCs and without structural heart disease by real-time 3-dimensional speckle tracking echocardiography (RT3D-STE). Patients and Methods: Forty patients were included in this study with asymptomatic frequent PVCs. Patients without structural heart disease was excluded. Detailed history, physical examination, full laboratory investigations, resting ECG, 24 hours Holter monitoring, conventional 2D echocardiography assessment of left ventricular ejection fraction (LVEF), strain imaging with measurement of LV-GLS, 2D speckle tracking and RT3D-STE (global longitudinal, area, radial, and circumferential strain (GLS, GAS, GRS, and GCS)). The study was performed at Islamic Cardiac Centre of Cardiology, Al-Azhar University during the period from September 2019 to April 2020. Results: RT3D-STE modalities detectap early subtle LV dysfunction better than conventional echocardiographic and showed a significant correlation with PVCs burden, origin, focality, interpolated PVCs and duration of the complex of ectopic beat. Conclusion: Frequent premature ventricular complexes could produce LV dysfunction and cardiomyopathy independently of any pre-existing underlying structure heart disease and early detection of subtle LV dysfunction can be done by RT3D-STE modalities even in asymptomatic patient.