Left ventricular (LV) dysfunction as identified by depressed systolic function is an independent predictors of mortality and hospitalization with ischemic cardiomyopathy. LV systolic function as defined by the ejection fraction (EF) is quantified using cardiac imaging. We hypothesize that subset of patients with ischemic cardiomyopathy and normal LV EF of 55% demonstrate impairment in cardiac contractility by strain imaging. The results showed that the nonlinear relationship between LVEF and myocardium global circumferential-strain is indicative that EF is not sensitive to regional cardiac dysfunction or LV remodeling. Cardiac strain should become the cornerstone of the evaluation of patients with ischemic cardiomyopathy.