Abstract: Background: Coronary slow flow (CSF) often links to inflammation and endothelial function disturbance. While conventional ejection fraction measurements fall short in identifying myocardial dysfunction, left ventricular global longitudinal strain (LV GLS) has shown superior efficacy in this regard. Our study aimed to explore subclinical left ventricular systolic dysfunction by assessing LV GLS in patients diagnosed with coronary slow flow (CSF). Methods: The study included sixty patients with CSF and sixty control individuals without CSF. Coronary angiography employed the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) to identify CSF. LV GLS values were evaluated and compared between the two groups. Results Significantly reduced LV GLS was evident in the CSF group compared to the control group (− 16.18 } 1.25 vs.− 19.34 } 1.33, p < 0.001). A notable correlation (r = 0.492, p < 0.001) between LV GLS and TFC was observed in the CSF group. Multivariate logistic regression analysis highlighted reduced LV-GLS (OR 2.2, 95% CI 1.57–3.09, p < 0.001)and smoking (OR 11.55, 95% CI 3.24–41.2, p < 0.001) as significant predictors for CSF presence. The receiver operating characteristic curve established that an LV GLS value of ≥ − 17.8% accurately predicted the presence of CSF (AUC:0.958, 95% CI: 0.924–0.991, p < 0.001) with 90% specificity and 91.7% sensitivity. Conclusion :Our study indicates that reduced LV GLS is associated with CSF presence, offering a valuable means to early detect subclinical left ventricular systolic dysfunction in high-risk patients susceptible to heart failure. Trial registration: ZU-IRB#7038/12-7-2021 Registered 12 July 2021, email: IRB_123@medicine.zu.edu.eg. Keywords: Coronary angiography, Coronary slow flow, Echocardiography, Myocardial dysfunction, LV strain