Background: Chagas heart disease has a high socioeconomic burden, and any strategy to detect early myocardial damage is welcome. Speckle-tracking echocardiography assesses global and segmental left ventricular (LV) systolic function, yielding values of two-dimensional strain (ε). The aim of this study was to determine if patients with chronic Chagas disease and normal LV ejectionfractions present abnormalities in global and segmental LVε. Methods: In this prospective study, patients with Chagas disease with no evidence of cardiac involvement (group I; n = 83) or at stage A of the cardiac form (i.e., with changes limited to the electrocardiogram) (group A; n = 42) and 43 control subjects (group C) underwent evaluation of global and segmental LV ε by speckletracking echocardiography. A subset of randomly selected patients in group A underwent cardiac magnetic resonance imaging and repeated echocardiography 3.5 6 0.8 years after the first evaluation. Results: Mean age, chamber dimensions, and LV ejection fraction were similar among the groups. Global longitudinal (group C, 19 6 2%; group I, 19 6 2%; group A, 19 6 2%), circumferential (group C, 19 6 3%; group I, 20 6 3%; group A, 19 6 3%), and radial (group C, 46 6 10%; group I, 45 6 13%; group A, 42 6 14%) LV ε were similar among the groups. Segmental longitudinal, circumferential, and radial LV ε were similar across the studied groups. Seven of 14 patients had areas of fibrosis on cardiac magnetic resonance imaging. Patients with fibrosis had lower global longitudinal ( 15 6 2% vs 18 6 2%, P = .004), circumferential ( 14 6 2% vs 19 6 2%, P = .002), and radial LV ε (36 6 13% vs 54 6 12%, P = .02) than those without cardiac fibrosis despite similar LV ejection fractions. Patients with fibrosis had lower radial LV ε in the basal inferoseptal wall than patients without cardiac fibrosis (27 6 17% vs 60 6 15%, P = .04). Conclusions: Patients with chronic Chagas disease and normal global and segmental LV systolic function on two-dimensional echocardiography had global and segmental LV ε similar to that of control subjects. However, those in the early stages of the cardiac form and cardiac fibrosis had lower global longitudinal, circumferential, and radial LV ε.