Several echocardiographic methods have been proposed to assist patient selection for cardiac resynchronization therapy. Color-coded tissue Doppler is one of the most promising methods to quantify mechanical dyssynchrony. However, tissue Doppler data are affected by Doppler angle of incidence and tethering or translational motion. Furthermore tissue Doppler based modalities are good for longitudinal motion analysis but limited in other directions of wall motion such as radial, circumferential, and rotational. Speckle tracking is a more recent technique that allows accurate calculation of regional radial and circumferential strain as well as regional rotation for dyssynchrony analysis. Although no ideal echocardiographic method exists that integrates regional dyssynchrony data in all contraction directions as yet, technical refinements and advances in understanding of pathophysiology will help to improve the study of mechanical dyssynchrony.