Lipedema is a lymphedema-masquerading symmetrical, bilateral and disproportional obesity. Its conservative maintenance treatment comprises the use of flat-knitted compression pantyhoses. Lipedema is known to be associated with left ventricular morphological and functional alterations. The present study aimed to assess the effects of graduated compression stockings on left ventricular (LV) rotational mechanics measured by three-dimensional speckle-tracking echocardiography (3DSTE) in lipedema patients. The present study comprised twenty lipedema patients (mean age: 45.8 ± 11.0 years, all females) undergoing 3DSTE who were also compared to 51 age- and gender-matched healthy controls (mean age: 39.8 ± 14.1 years, all females). 3DSTE analysis was performed at rest, and subsequent to 1 hour application of compression class 2 made-to-measure flat-knitted pantyhose. Six lipedema patients showed significant LV rotational abnormalities. Of the remaining fourteen lipedema patients LV basal rotation rotation showed significant reduction, while LV apical rotation showed significant increase with unchanged LV twist after a 60-minute use of compression garment. Significant changes in LV rotational mechanics could be detected among 14 women with lipedema after the use of compression garment however six probands have special LV rotational abnormalities at baseline and/or after compression. © 2020 World Obesity Federation.