This narrative review aims to discuss the potential applicability of speckle-tracking echocardiography (STE) in patients under mechanical ventilation (MV) and mechanical circulatory support (MCS). Both its benefits and limitations were considered through critical analyses of the current available evidence. DATA SOURCES AND STUDY SELECTION: A literature search was conducted in PubMed and Excerpta Medica Database indexed databases (2012-2021). In addition, the reference lists of all selected studies were manually scanned for further identification of potentially relevant studies. DATA EXTRACTION: The terms "Speckle-Tracking Echocardiography," "Mechanical Ventilation," "Mechanical Circulatory Support," "Extracorporeal Membrane Oxygenation," "Ventricular Assist Devices," and "Left Ventricular Unloading Devices" were searched for the identification of relevant articles for narrative synthesis. DATA SYNTHESIS: STE is a well-established post-processing method of analyzing myocardial function, with potentially greater clinical utility than conventional 2D echocardiography. STE has been incorporated into the guideline recommendations for both the diagnostic and prognostic evaluations of myocardial and valvular pathologies. However, the potential of STE application within critical care settings has not yet been fully realized. Its utility in the assessment of patients undergoing MV and MCS is substantial. Specifically, it may serve as an ideal modality in the assessment of subtle changes in cardiac function. In the limited number of studies reviewed, STE was consistently a more sensitive marker of myocardial functional change, compared with traditional markers of 2D and Doppler parameters during changes in MV and MCS. CONCLUSIONS: Although current evidence is extremely limited, STE strain is suggested to be a more sensitive and reproducible parameter of myocardial function than conventional echocardiographic parameters and may have value in the assessment of patients undergoing MV and MCS in critical care settings. Further studies in larger populations are required to elucidate STE's prognostic capability and its value as a point-of-care tool in guiding clinical practice for subjects under MV and MCS.