Background: SPECT Myocardial Perfusion Imaging is a widely used, non-invasive imaging modality routinely employed in the diagnosis of coronary artery disease. An advanced, non-invasive imaging technique that allows for a quick and accurate evaluation of both global and regional left ventricular function is speckle tracking echocardiography. Objective: This study aimed to assess the predictive value of quantitative SPECT MPI and resting left ventricular segmental strain analysis using 2D Speckle Tracking Echocardiography in determining the severity of coronary artery disease. Patients and Methods: Fifty patients with positive SPECT MPI underwent echocardiography to obtain segmental and average global longitudinal strain. Stress Gated-SPECT MPI was used to assess segmental MPI uptake. Additionally, coronary angiography was performed on all patients. Results: Patients' mean age was 55.5 ± 8.16 years. Dyslipidemia was present in (70%) of the patients. The LAD, LCX and RCA were affected in 40%, 26% and 34% of patients respectively. A strong positive correlation was found between LAD and LCX MPI uptake during stress and GLS, but no significant correlation was observed in RCA territories. A positive correlation was observed between the degree of LAD stenosis and basal anterior, basal anteroseptal GLS, and a Significant negative correlation with apical anterior GLS. However, for RCA and LCX no segmental GLS were correlated. A positive correlation was found between MPI EF and average GLS, circumferential and peak radial strain. Conclusion: Speckle tracking Echocardiography is superior to conventional Echo and non-inferior to myocardial perfusion imaging in the detection of coronary artery disease.