Left ventricular hypertrophy (LVH) is a common finding from cardiac imaging in daily clinical practice. Presence of LVH is a poor prognostic factor for cardiovascular diseases. Variable reasons caused LVH, including athletes, arterial hypertension, aortic stenosis, hypertrophic cardiomyopathy, and infiltrative heart disease such as cardiac amyloidosis and Fabry disease. Although traditional echocardiography can be used for diagnosis of LVH, quantification of left ventricular mass, and identification of aortic stenosis, it is difficult to differentiate diseases involved in myocardium. Myocardial deformation imaging (strain image) is a new modality by using speckle tracking echocardiography. Strain imaging can be used for better evaluation of LVH. This article reported 3 cases of LVH, addressing roles of strain imaging, and with literature review for the application of strain imaging in evaluation of LVH.   (J Intern Med Taiwan 2022; 33: 323-331)