Background: Ischemia plays a pivotal role in the development and progression of both types of HF (HFrEF & HFpEF). Strain echocardiography, performed by using the speckle tracking technique, can identify subclinical left ventricular dysfunction before left ventricular ejection fraction declines. Objective: To assess left ventricular systolic function by different noninvasive imaging modalities in patients with chronic ischemic heart disease. Patients and methods: This study was done at Al Zahra University Hospital from November 2017 till January 2020. It included 80 patients (group I) with chronic ischemic heart disease (IHD), they were 60 males (75%) and 20 females (25%) with mean age 53.5±8.08, and 15 apparently healthy age and sex matched subjects as a control group (group II), they were 11(73.3%) females and 4(26.7%) males with mean age 53.2±7.7. Group I was further sub-classified to impaired and preserved according to their LVEF assessed by 2D echo, speckle tracking echo global longitudinal strain (STE-GLS), tissue Doppler imaging (TDI) strain, TDI Sa and gated SPECT LVEF. Results: The ischemic (group I) showed a statistically significant decrease in the average Sa 5.45±1.69 VS group II 8.7± 0.73 (P value < 0.001), lower LVEF 2D echo in group I 46.3±9.68 compared to group II 58.9±4.68 (P value < 0.001), decrease in gated SPECT LVEF in group I 56.4±13.98 VS group II 67.067±5.66 (P value < 0.001), statistically significant reduction in left ventricular global longitudinal strain (LV-GLS) (-13.89±18.99) in group I vs -21.24±1.23 in group II (P value <0.05). The highest percentage of patients with impaired LV systolic function were those who assessed by STE-GLS (74 patients 92%), 72 patients (90%) impaired LVEF by TDI Sa, 60 patients (75%) impaired LVEF by 2D echo, and by TDI strain, and 22 patients (27.5%) impaired LVEF by gated SPECT. Conclusion: STE is considered the most sensitive method in assessment of subclinical LV systolic dysfunction and is considered superior to other methods.