BACKGROUND: The high incidence of coronary heart diseases requires early diagnosis to prevent complications. This study aims to assess the mean value of tissue mitral annular displacement (TMAD), using Speckle tracking echocardiography (۲D STE) in patients with coronary artery stenosis.METHODS: ۱۴۹ patients aged ۵۰ to ۷۶ years were included in this cross-sectional study who were admitted with primary diagnosis of acute coronary syndrome (ACS) to the emergency department. In all patients, the TMAD data were measured using ۲D speckle tracking technology.RESULTS: ۱۴۹ patients with a mean age of ۶۱.۸۳ ± ۷.۱۴ years old were studied. Regarding the involved coronary artery as left anterior descending (LAD), right coronary artery (RCA), or left circumflex artery (LCX), the TMAD data was reduced significantly (P < ۰.۰۰۱) in the relevant walls [base of anterior and anteroseptum (۴.۴۶ ± ۳.۵۳ mm), base of inferior and inferoseptum (۴.۹۱ ± ۳.۸۱ mm), and base anterolateral and inferolateral walls (۵.۵۳ ± ۳.۸۲۷ mm), respectively.] TMAD in anterior, inferior, and lateral ST-elevation myocardial infarction (STEMI) were ۲.۶۴ ± ۰.۸۷۰, ۴.۷۸ ± ۳.۸, and ۲.۸۰ ± ۰.۸۳ mm, respectively which were significantly reduced compared to the non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (P < ۰.۰۰۱). TMAD in different LV function categories was only reduced in those with LAD lesion and with severe LV systolic dysfunction (۲.۴۷ ± ۰.۸۳۴ mm, P < ۰.۰۰۱).CONCLUSION: The current study describes a significant relationship between TMAD and left ventricular function, ACS type, and the culprit coronary artery. In different types of ACS, the TMAD value was worse in the subgroups of STEMI and in the walls affected by the stenosed coronary artery. This method might be helpful in defining the culprit coronary artery.