Objective To investigate the correlation and application value of echocardiography in detecting epicardial adipose tissue (EAT) and left ventricular longitudinal strain peak time dispersion (TSD) with coronary stenosis. Methods A total of 77 chest pain patients who underwent coronary angiography were divided into three groups based on the degree of stenosis: normal or <50% (group A), 50-75% (group B), and >75% (group C). EAT measurements were obtained for each group, and QLAB software was used to analyze the left ventricular global long-axis strain (GLS) and TSD. The correlation and predictive value of EAT and TSD with coronary stenosis were then analyzed. Results The EAT values in group C (6.19±2.05 mm) were higher than those in group B (5.02±1.16mm) which, in turn, were higher than those in group A(3.24±1.13 mm)(p<0.05). TSD showed statistical significance among groups B, C, and A(p<0.05), while GLS did not(p>0.05). There was a correlation between EAT, TSD, and the degree of coronary artery stenosis(r=0.62, p<0.01; r=0.31,p<0.01). The Youden indexes of EAT with 5.31mm as the threshold, TSD with 30.65ms as the threshold and EAT combined with TSD to predict severe coronary artery stenosis were 0.54, 0.18 and 0.56, and kappa=0.415 for EAT combined with TSD(p<0.01), respectively. Conclusion The detection of EAT and TSD by echocardiography can serve as predictive indicators for the degree of coronary artery stenosis, and the combination of EAT and TSD has higher diagnostic accuracy for moderate or severe coronary artery stenosis.