<p>Normal pericardium plays a fundamental role in the maintenance of left ventricular (LV) twists. Pericardial diseases are among the important causes of morbidity and mortality in cases with cardiovascular diseases. The thorough management of suspected pericardial diseases requires early diagnosis using optimal imaging modalities for each patient. Strain and strain rate could be calculated using two-dimensional speckle-tracking echocardiography (STE) through tracking frame-to-frame movements of myocardial tissue. This modality could also determine the LV torsion and rotation. Ultrasonic strain imaging can evaluate LV function without being influenced by the whole heart motion or even tethering forces. This imaging modality could also identify the disease at earlier stages. This report reviews the role of strain imaging by echocardiography in the assessment of pericardial diseases including acute pericarditis, perimyocarditis, chronic constrictive pericarditis, effusive constrictive pericarditis, and transient constriction, pericardial tamponade, post pericardiectomy, pericardial cysts, masses, diverticula and congenital absence of the pericardium. Being familiar with obtaining data from strain imaging using STE could help pericardial specialists working in established pericardial centers of excellence.</p>