Objective The aim of this study was to evaluate the role of three dimensional (3D) speckle tracking echocardiography (STE) in the detection of subclinical left ventricular (LV) myocardial injury in patients with prediabetes. Methods The study included 41 patients with prediabetes and 40 age- and gender- matched healthy individuals. Conventional echocardiographic parameters were measures and 3D Speckle tracking imaging of the peak systolic strain(3D-GLS, 3D-GAS, 3D-GCS and3D-GRS ) were recorded. Results LVEF, LVEDV, LVESV,and 3D-GRS, 3D-GAS, 3D-GCS were similar between prediabetes and controls (P＞0.05). 3D-GLS was significantly reduced in patients with prediabetes compared to controls (P<0.05).Correlation analysis showed that 3D-GLS negatively correlated with waist hip ratio（r=-0.534，P=0.003）, BMI（r=-0.443，P=0.01）and HbA1c（r=-0.587，P＜0.001）.Multivariate regression analysis showed that HbA1c is an independent risk factor for left ventricular longitudinal systolic dysfunction. Conclusion Patients with prediabetes have evidence of subclinical LV myocardial injury. Three-dimensional global longitudinal strain appears to be useful and sensitive index in detection of subclinical LV dysfunction in patients with prediabetes.