Introduction: Renal transplantation (RT) increases survival in end‐stage kidney disease patients but cardiovascular diseases remain the leading cause of morbidity and mortality. We evaluated the role of myocardial strain (2DSTE) indices and dipyridamole‐induced (DIPSE) changes in echocardiographic parameters at baseline for the prediction of clinical events and echocardiographically assessed deterioration of cardiac function in a RT population. Methods: Forty‐five RT patients underwent an echocardiographic study at baseline including 2DSTE and DIPSE. If no cardiovascular/renal event occurred, patients were investigated at 3‐year follow‐up; eight patients presented a clinical event while 37 patients were re‐evaluated. Results: Coronary flow reserve (CFR) was abnormal in 24% of the population. DIPSE induced improvements in classic and 2DSTE systolic and diastolic echocardiographic indices including TWIST, UNTWIST, global longitudinal strain (GLS), and circumferential strain (P <.05 for all). Compared to baseline, deteriorations in E/E', LVEF, E', and TWIST were observed at follow‐up (P <.05 for all). DIPSE‐induced changes in GLS, global radial strain, and LVEF were associated with changes in these indices at follow‐up (P <.05 for all). Higher LV mass index, E/E', and lower MAPSE, E', and CFR at baseline were associated with the occurrence of clinical events at follow‐up (P <.05 for all). Conclusions: In RT patients, coronary vascular dysfunction (ie, low CFR) was associated with the occurrence of adverse events. DIPSE‐induced changes in myocardial strain and classic echocardiographic indices could identify individuals with a subclinical deterioration in cardiac function at follow‐up. This may indicate that DIPSE could serve as a means to assess myocardial reserve in this population.