Objective To explore the evaluation value of three-dimensional ultrasonic speckle tracking echocardiography (3D-STE) for left ventricular function in elderly patients with coronary heart disease (CHD) and hypertension (EH). Methods A total of 60 elderly patients with CHD and EH admitted to Sinopharm Dongfeng General Hospital Affiliated to Hubei Medical College-Hubei Provincial Clinical Medical Research Center for Hypertension were enrolled as combined CHD group between March 2021 and March 2022, while 60 patients only with EH during the same period were randomly enrolled as simple EH group. All underwent 3D-STE to detect left ventricular function. The left atrial volume parameters, ejection fraction, global strain peak of left ventricle, carotid intima-media thickness (IMT), peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), stenosis degree and score of carotid plaques (Crouse) were compared between the two groups. The independent risk factors of left ventricular function changes in elderly patients with CHD and EH was analyzed by multivariate Logistic regression analysis. Results 3D-STE showed that left atrial volume parameters and LAAEF in combined CHD group were higher than those in simple EH group, while LATEF and LVEF were lower than those in simple EH group (P<0.05). 3D-STE showed that there were significant differences in global strain peak of left ventricle (left ventricular overall area, circumference, radial and longitudinal peak systolic strain) between the two groups (P<0.05). 3D-STE showed that PALS and PACS of entirety, four-chamber and two-chamber in combined CHD group were lower than those in simple EH group (P<0.05). 3D-STE showed that there were significant differences in IMT, stenosis degree and Crouse score between the two groups (P<0.05). The results of Logistic regression analysis showed that LAAEF, GAS, IMT, stenosis degree and Crouse score were all risk factors of left ventricular function changes in elderly patients with CHD and EH (P<0.05). Conclusion 3D-STE can better evaluate local and global systolic function of left ventricle, which has certain evaluation value for left ventricular function in elderly patients with coronary heart disease and hypertension.