Abstract: Techniques are disclosed for pacing site selection. In one example, a method includes using a sensing element such as an ultrasonic transducer, an optical pressure sensor, a MEMS pressure sensor, a SAW pressure sensor, an accelerometer, a gyroscope, or any other suitable sensing element to sense a measure related to a cardiac strain in a heart resulting from contraction and relaxation of myocardium during a cardiac cycle. Based on the sensed strain, an output may be provided for use by a user of the system to select a segment of the heart for lead placement.