Objective To explore the left ventricular subclinical myocardial involvement in patients with systemic sclerosis by two-dimensional speckle tracking imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE). Method Thirty-three patients diagnosed with systemic sclerosis without obvious structural heart disease and pulmonary hypertension in our hospital were selected as the study group, including 16 patients with positive anti-Scl-70 antibody or anti-Ro52 antibody, and 17 patients with negative antibodies. Another 33 healthy volunteers at the same time were selected as the control group. The clinical and laboratory data of the two groups were collected, the ultrasonic parameters were obtained by conventional echocardiography, two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography. The differences of the above parameters in each group were compared. Results Compared with the control group, the global longitudinal strain parameters of the study group were reduced, and the differences in strain parameters of the 16 segments in the 18-segment bull 's eye diagram were statistically significant (P < 0.05), mainly in the basal and middle segments. There was no significant difference in the global circumferential strain parameters between the study group and the control group (P > 0.05). The LVEDV and 3D-LVEF in the study group were lower than those in the control group (P < 0.05), and the synchrony parameters (Tmsv-16-SD, Tmsv-16-Dif, Tmsv-16-SD%, and Tmsv-16-Dif%) were longer than those in the control group (P < 0.05). Left ventricular systolic synchrony parameters were significantly negatively correlated with 3D-EF. Conclusions In SSc without obvious cardiovascular symptoms with preserved ejection fraction, the left ventricular global longitudinal strain capacity and left ventricular wall myocardial motion synchrony have been reduced, 2D-STI and RT-3DE are helpful for early detection of left ventricular subclinical myocardial involvement in SSc, and provide a new basis for early clinical diagnosis, early treatment and efficacy evaluation.