The accurate evaluation of left ventricular (LV) function has been central to monitoring of therapy, institution of specific therapeutic interventions and as a prognostic marker for risk stratification in a variety of cardiovascular conditions. However, LV ejection fraction, the most commonly used measure of LV systolic function, is a ‘coarse’ measure of global LV function, with several limitations. Strain analysis, a measure of myocardial deformation, has come to the forefront more recently as a more sensitive measure of myocardial function than LV ejection fraction. Its utility in detection of early subclinical LV dysfunction, defining regional variation in specific cardiomyopathies, utility to monitor improvement with therapy and as a prognostic marker in a variety of cardiac conditions has led to its increasing use in clinical practice. This review will briefly summarise specific methodological aspects, use in diagnosis and prognostic utility of strain analysis in various cardiovascular conditions.