Objective Three dimensional speckle tracking imaging technology (3D-STI) was used to evaluate the overall left ventricular systolic function of uremic patients with different ventricular configurations before renal transplantation, and to explore its clinical significance. Methods 85 uremic patients undergoing renal transplantation were divided into four groups according to different left ventricular configurations: left ventricular normal geometric (LVN group); left ventricular centripetal remodeling group (LV-CR group); left ventricular centripetal hypertrophy (LV-CH group) and left ventricular eccentric hypertrophy (LV-EH group). Another 24 cases with normal physical examination indexes in our hospital in the same period were selected as the control group. The three-dimensional global strain parameters of left ventricle in five groups were measured and compared - Global circumferential strain (GCS), global radial strain (GRS) and global longitudinal strain (GLS) were measured and compared. Results ① Compared with the control group, the levels of GLS in uremia group decreased, and the levels of GRS and GCS in LV-CH group and LV-EH group decreased (P < 0.05); Compared with LVN group, the levels of GLS, GRS and GCS in LV-CH group and LV-EH group decreased (P < 0.05); Compared with LV-CR group, the levels of GLS, GCS and GRS in LV-CH group and LV-EH group decreased (P < 0.05); Compared with LV-CH group, GLS and GCS inLV- EH group decreased (P < 0.05). ② According to ROC curve, three-dimensional speckle tracking technology can sensitively detect myocardial remodeling, and GLS is the most sensitive. ③ Repeatability test: the measurement results of GLS measured by 3D-STI technology within and between observers are relatively stable and have good consistency. Conclusion 3D-STI technology can effectively evaluate the left ventricular systolic function of uremic patients with different ventricular configurations before renal transplantation,help to reasonably select receptors, formulate individualized treatment plans, and better improve the prognosis of patients.