Background: While post-systolic shortening is a common finding on 2D speckle tracking by echocardiography, its significance for diagnosis relative to other imaging modalities has not been defined Methods: We studied 21 patients (14 males, mean age 56±14 years) with echocardiography and positron emission tomography (PET). Longitudinal strain by 2D speckle tracking (Echo pac PC GE medical) was performed in the standard 2, 3 and 4-chamber views. The patients also underwent PET resting rubidium and FDG cardiac scan within two weeks of the echo study.Holosystolic stretch with post-systolic shortening was defined as stretching of the myocardial segment >50% of the systolic time coupled to shortening after aortic valve closure. PET studies were analyzed using a 17-segment model as normal, hibernating or scarred myocardium Results: Longitudinal strain by 2D speckle tracking was feasible in 316 out of 357 segments. Holosystolic stretch with postsystolic shortening occurred in 69 out of 82 scarred myocardial segments. It also occurred in 9 non-scarred segments. Specificity and sensitivity of these findings were 96 % and 84% respectively, with positive, negative predictive value and accuracy of 88%, 94%, and 93% respectively. Conclusions: Holosystolic stretch with post systolic shortening is a highly specific and fairly sensitive measure to identify scarred myocardial segments on 2D strain imaging