Background: Transplanted hearts (TXH) show gradual irreversible decline in left ventricular (LV) compliance leading to chronic changes in diastolic function, while LV ejection fraction (EF) remains preserved by hypertrophy of intact myocytes. We hypothesized that chronic biomechanical changes in TXH would produce unique alterations in LV deformation patterns that are independent of injuries related to transplant rejection. Methods: 30 patients with TXH (LV EF = 57짹10 % at 314짹110 days); 23 with no previous rejection (58짹11 yrs, 18 male), 7 with previous rejection (57짹9 yrs, 4 male) and 18 healthy controls (46짹18 yrs, 8 male) underwent transthoracic echocardiography. Longitudinal, circumferential and radial strains (LS, CS and RS), and rotation were averaged from LV apical, mid and basal segments using 2D speckle tracking. Results: LS and CS in TXH were significantly reduced with a loss of the normal apex-to-base gradient of shortening (Table). RS was spared in mid segment and exaggerated in apical segments although LV apical rotation was reduced. TXH with previous rejection showed only reduction of the LS in apical segments (Table). Conclusion: Global LV EF in TXH is preserved despite reduction in longitudinal and circumferential strains due to a compensatory increase in radial strain. Knowledge of unique cumulative alterations in myocardial mechanics that evolve independent of changes due to transplant rejection may impact clinical assessment of long term prognosis in heart transplant recipients.