Objective: To explore the application value of three-dimensional speckle tracking imaging (3D-STI) in the diagnosis of patients with aortic stenosis (AS) of different risk stratification. Methods: A total of 79 patients with AS admitted to the hospital and 36 healthy volunteers were enrolled as research objects between January 2020 and December 2021. According to the severity of AS, they were divided into control group (36 cases), mild group (30 cases), moderate group (25 cases) and severe group (24 cases). All underwent routine ultrasound and 3D-STI examinations. The left ventricular posterior wall thickness (LVPWT), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), interventricular septum thickness (IVST) and left ventricular end-systolic diameter (LVSD) were detected by routine ultrasound. The global area strain (GAS), LVEF, global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), 3D-strain, torque, twist and rotation were detected by 3D-STI. The correlation between AS severity and 3D-STI parameters was analyzed by Spearman analysis. Results: The routine ultrasound showed that levels of LVPWT and IVST in severe group were significantly higher than those in the other three groups (P<0.05). 3D-STI showed that GCS in moderate group and severe group was significantly higher than that in the other two groups, while levels of GRS and GLS were significantly lower than those in the other two groups. The above changes were more significant in severe group than moderate group (P<0.05). 3D-strain level in the three groups was significantly lower than that in control group, while torque, twist and rotation were significantly higher than those in control group (P<0.05). The severity of AS was positively correlated with LVPWT, IVST, GCS, torque, twist and rotation (r_LVPWT=0.522, P_LVPWT=0.000; r_IVST=0.648, P_IVST=0.000; r_GCS=-0.637, P_GCS=0.000; r_torque=0.552, P_torque=0.000; r_twist=0.523, P_twist=0.000; r_rotation=0.648, P_rotation=0.000), while negatively correlated with GRS, GLS and 3D-strain (r_GRS=-0.680, P_GRS=0.000; r_GLS=-0.581, P_GLS=0.000; r_3D-strain=0.700, P_3D-strain=0.000). Conclusion: The severer the severity of AS, the greater the damage to cardiac function. 3D-STI can assess the risk in the early stage, with good effect.