Background Two-dimensional strain echocardiography by speckle tracking method is known to be new alternatives of Tissue Doppler Imaging technique in quantitative method of evaluating myocardial function. We tried to evaluate myocardial ischemia by 2D strain echocardiography during resting and after exercise. Methods Total 25 patients were evaluated. After baseline echocardiogram was obtained, Treadmill exercise test was done. Immediately after peak exercise(IAPE), another images(three apical view and short axis view) for 2D strain echo were obtained. Peak systolic strain, Peak systolic strain rate at rest and IAPE were analyzed. Invasive coronary angiography were done in all patients and we checked location of significant coronary artery stenosis. Results Total 25 patients were undergone coronary angiography. 10 patients had significant coronary artery stenosis(SCAS) more than 1 vessel. The patients with SCAS had significant lower average peak strain (-14 짹 2.35 vs. -18 짹 2.17 %, p=0.009) at resting, lower average peak strain (-16.8 짹 3.02 vs. -19.6 짹 0.72 %, p=0.05) and strain rate (-0.99 짹 0.18 vs. -1.28 짹 0.28 /s, p=0.05) at IAPE than patients without SCAS. On LAD territory, resting peak strain and strain rate at midanterior wall is decreased significantly. On LCX territory, resting peak strain rate at apicallateral wall was decreased significantly. About RCA territory, strain rate of basalinferior wall was reduced in patients with SCAS. But in this study, there were tendency of decreasing peak strain and strain rate of each segment after IAPE. Conclusion 2D speckle tracking strain echocardiography may be alternative and useful noninvasive test in assessment of coronary ischemia.