Objective: To evaluate early changes in left ventricular systolic function in patients with systemic lupus erythematosus (SLE) using three-dimensional speckle tracking imaging (3D-STI). Methods: Thirty SLE patients and 30 healthy people (control group) were selected, the patients were further divided into subgroups according to their Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index (SELENA-SLEDAI) score: SELENA-SLEDAI ≤ 12 (mild-to-moderate group), SELENA-SLEDAI > 12 (severe group). Blood samples were obtained from patients and laboratory investigations were performed. All participants were examined using 3D-STI, the 3D conventional and strain parameters were obtained. The above parameters were compared in the three studied groups. Receiver operating curves (ROC) were prepared for above parameters and analyzed to identify correlations among LVEF, GLS, GCS, LVtw, Tor, MCI and hs-TropT. Results: Compared with the control group, the absolute values of LVEDV, LVEF, GLS, GCS, LVtw, Tor and MCI decreased, LV EDmass, LV ESmass and PSD increased in the mild-to-moderate and the severe groups (P2 < 0.05, P3 < 0.05). There was statistically significant difference in terms of strain parameters between the mild-to-moderate group and the severe group (P1 < 0.05). The highest area under the ROC for MCI was 0.909, the highest sensitivity for MCI was 90.00%, and the highest specificity for Tor was 86.67%. Correlation analysis showed that there was a good correlation between the MCI and hs-TropT (r = − 0.677). Conclusion: 3D-STI technology may help detect early changes in left ventricular systolic function in patients with SLE