Back grounds The assessment of carotid artery intima media thickness(CIMT) has been used as a surrogate marker of atherosclerosis. However, it may have a difficulty to measure CIMT when the image is not good for the delineation of IMT, and CIMT reflects only focal change of the specific region. Recently developed 2 dimensional speckle tracking has the possibility to evaluate the deformation property of vasculature objectively and may predict the presence of atherosclerotic disease. The aim of this study was to investigate the relationship between strain of common carotid artery(CCA) and the presence of coronary artery disease(CAD). Methods Consecutive patients who underwent carotid artery ultrasonography were enrolled in this study. The patients who had a history of cerebrovasular disease, carotid artery stenosis or significant arrhythmia were excluded. The presence of CAD was defined as more than 50% stenosis of any coronary artery on coronary angiography. Circumferential strain and strain rate of left CCA were acquired from ultrasonographic 2D carotid image by speckle tracking method. The CIMT of each patient was measured at far wall of left CCA 1cm distal to the bulb over a length of 1cm. Results Total 60 patients were included for the analysis and 19 patients had CAD. There were no differences in the diameter of CCA(p=0.95) and the CIMT(p=0.09). However, the presence of CAD was negatively related to strain and strain rate of carotid artery (strain, 2.45짹1.08% vs 3.16짹1.26%, p=0.03; strain rate, 0.34짹0.15/s vs 0.48짹0.19/s, p=0.004, respectively). There was no relation of strain or strain rate to CIMT(p=0.30 and p=0.36, respectively). Conclusion Strain and strain rate of CCA were lower in patients with CAD than in patients with no CAD, but CIMT was not significantly different. The elastic properties of carotid artery associated with atherosclerosis were objectively evaluated by ultrasonographic 2D strain imaging and can be a noninvasive tool to assess the presence of CAD.