Abstract Objectives: To evaluate the characteristics of longitudinal layer-specific strain of Left Ventricular (LV) in patients with chronic severe aortic regurgitation (AR) by two-dimensional speckle tracking echocardiography (2D-STE), and to explore the correlation between longitudinal layer-specific strain and geometry. Methods: Forty-three patients with chronic severe AR and 20 healthy volunteers were prospectively selected for traditional two-dimensional echocardiographic measurement. The global and segmental longitudinal strain of endocardial (LSendo), mid-myocardial (LSmid), epicardial (LSepi), and global longitudinal layer-specific strain transmural gradient (TG) acquired by 2D-STE. The difference of parameters between the control group and the AR group was compared, and the correlation between global longitudinal layer-specific strain and geometry was analyzed. Results: (1) Compared with the control group, the LV end-diastolic diameter index (LVEDDI), LV end-systolic diameter index (LVESDI), LV end-diastolic volume index (LVEDVI), LV end-systolic volume (LVESVI), Posterior wall thickness (PWT), Interventricular septum thickness (IVST), Left atrial dimension (LAD), LV mass index (LVMI) and Spherical index (SPI) were significantly increased in the AR group, while the LV ejection fraction (LVEF) was decreased (P < .001); (2) The global LSendo, LSmid, LSepi and TG in the AR group were lower than those in the control group (P < .001). (3) In the AR group, there was no significant difference in the longitudinal strain (LS) from endocardial to epicardial. From the base to the apex, the increasing trend of the LSendo disappeared, and the LSmid and LSepi were decreasing. (4) There was negative correlation between the LV global longitudinal layer-specific strain and the geometric parameter (P < .001). Conclusions: The changes of value and pattern of longitudinal layer-specific strain of LV in patient with chronic severe AR can be quantitatively evaluated by 2D-STE which has important guiding value for the treatment of patients with chronic severe AR.