This study aimed to investigate the diagnostic value of combined echocardiography and residual cholesterol in asymptomatic myocardial ischaemia. One hundred and fifty-seven patients were seen at Hefei BOE Hospital from 2019 to 2022. The patients were divided into two groups, the observation group (n=90, confirmed asymptomatic myocardial ischaemia) and the control group (n=67, negative diagnosis), based on coronary angiography. The observation group had significantly higher residual cholesterol levels (p=0.001). A combined approach of echocardiography and serum residual cholesterol values showed statistically higher accuracy (p<0.05), with ROC curve analysis supporting the superiority of this method [AUC 0.788 (0.711-0.865), Yoden index 0.576]. It also demonstrated higher sensitivity (88.9%) and specificity (68.7%). The study concluded that combined echocardiography and serum residual cholesterol testing offer superior diagnostic efficacy and practicality for asymptomatic myocardial ischaemia, recommending it for the clinical use. Key Words: Echocardiography, Residual cholesterol, Asymptomatic myocardial ischaemia, Diagnosis.