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Aim: It is known that the apical rotation assessed by speckle tracking echocardiography (STE) is an effective non-invasive parameter reflecting the global contractility of the left ventricle (LV).The change of its direction and loss of left ventricular torsion is associated with significant left ventricular remodeling, advanced electrical dyssynchrony, reduction of systolic function, increased filling pressures and indicates the development of heart failure. The aim of this study was to investigate the main parameters assessed by three-dimensional (3D) STE to distinguish between ischemic and nonischemic etiology of heart failure (HF). Methods: 38 patients with moderate to severe systolic LV dysfunction were included into this study. 19 patients (age 64.6 ± 9.1 years, EF 27.7 ± 11.3%) had history of myocardial infarction (IM), revascularization or > 75% occlusion of one or multiple epicardial arteries assessed by selective coronarography. 19 patients (age 67.6 ± 10.0 years, EF 27.3 ± 7.7%) had no significant coronary disease. All patients have undergone two-dimensional (2D) and 3D transthoracic echocardiography (TTE). In addition to standard echocardiographic parameters, using 3D STE, we assessed global longitudinal strain (GLS) and rotational parameters of LV Results: There were no differences in standard TTE and STE parameters including GLS (-8.1 ± 4.6 vs. -8.3 ± 3.0%, p = 0.42) between the two groups of patients. Significant differences were detected only in the LV apical rotation (5.0 ± 3.6 degrees vs. 2.3 ± 2.4 degrees, p <0.004). The cut-off value to distinguish between ischemic and non-ischemic HF etiology was 3.16 ° (AUC 0.77; 95% CI, 0.61 to 0.89; p <0.0009). Conclusion: According to our results, the apical rotation assessed by 3D STE is significantly lower in patients with nonischemic etiology of HF. This finding could serve for noninvasive differentiation of HF related to dilated cardiomyopathy and CAD. [ABSTRACT FROM AUTHOR]