Speckle tracking based on block matching is the most common method for multi-dimensional motion estimation in ultrasound elasticity imaging. Extension of 2-D methods to 3-D has been problematic because of the large computational load of 3-D tracking, as well as performance issues related to the low frame (volume) rates of 3-D images. To address both of these problems, we have developed an efficient two-pass tracking method suited to cardiac elasticity imaging. PatchMatch, originally developed for image editing, has been adapted for ultrasound to provide first-pass displacement estimates. Second-pass estimation uses conventional block matching within a much smaller search region. 3-D displacements are then obtained using correlation filtering previously shown to be effective against speckle decorrelation. Both simulated and in vivo canine cardiac results demonstrate that the proposed two-pass method reduces computational cost compared with conventional 3-D exhaustive search by a factor of 10. Moreover, it outperforms one-pass tracking by a factor of about 3 in terms of root-mean-square error relative to available ground-truth displacements.