Background: Two dimensional (2D) strain based on speckle tracking has been proposed as a simple and reproducible tool to detect systolic dysfunction. We sought to evaluate whether 2D strain predict clinical events regardless of left ventricular ejection fraction (LVEF), if so, which strain parameter best predicts events in heart failure. Methods: A total 201 hospitalized patient (age 63 짹 11, LVEF = 34 짹 13%) for heart failure underwent clinical evaluation, conventional and tissue Doppler echocardiography. Using dedicated software (EchoPac), we measured global longitudinal (L) 2D strain or strain rate (SR) in apical 4 and 2 chamber views and circumferential (C) strain or SR in parasternal short axis view. Clinical events were defined as readmission for heart failure, transplantation, or cardiac death. Results: There were 23.4% clinical events during 39 짹 17 months follow-up. Age, LA volume, all SR of each view and C strain are predictive of events, but not apical strain. In Cox models adjusted for age, LVEF and LA volume, C-SR is independently associated with events (p = 0.01). Of all strain parameters, global C-SR showed the greatest area under the curve (0.70, p < 0.01) and optimal cut off was -0.69/s with 70% sensitivity and 66% specificity. On Kaplan-Meier analysis, event free survival was 60 짹 2 months in C-SR < -0.69/s vs 46 짹 3 months in ��� -0.69/s (p < 0.01). Conclusion: The global C-SR based on speckle tracking is a powerful predictor after adjustment for age, LA volume, and LV EF in patients with hospitalized heart failure.