Objective To investigate the clinical value of two-dimensional speckle tracking echocardiography (2D-STE) in the early assessment of coronary artery stenosis.Methods A total of 100 coronary heart disease (CHD) patients who underwent coronary angiography (CAG) and 2D-STE were enrolled and categorized into mild (Gensini score < 25, n = 34), moderate (25 to 49, n = 24), and severe (≥ 50, n = 35) stenosis groups, with 25 controls showing normal coronary arteries. Differences in global longitudinal strain (GLS), segmental longitudinal strain (LS), peak strain dispersion (LS-PSD), and maximum peak time difference (LS-Dif) were analyzed. Multivariate linear regression identified factors influencing stenosis severity, with receiver operating characteristic (ROC) curves plotted.Results The severe group showed higher GLS than control, mild, and moderate groups (P < 0.05); the moderate group exceeded control and mild groups (P < 0.05); the mild group surpassed controls (P < 0.05). LS-PSD was greater in severe and moderate groups versus control and mild groups (P < 0.05), with no significant difference between moderate and severe groups (P > 0.05). LS-Dif followed similar trends. GLS and segmental LS were independent risk factors for stenosis severity (P < 0.05). For 75 ~<90% stenosis, segmental LS (cutoff: -14.0%) showed optimal diagnostic performance (AUC=0.819; sensitivity=60.75%; specificity = 79.13%). For ≥ 90% stenosis, GLS (cutoff: -12.5%) demonstrated superior efficacy (AUC= 0.877; sensitivity = 70.97%; specificity = 92.86%).Conclusion 2D-STE serves as a safe, noninvasive adjunct to CAG for early coronary stenosis evaluation in CHD patients.