Background Coronary flow velocity (CFV) pattern predicts the functional recovery of damaged myocardium after reperfusion in patients with acute myocardial infarction (AMI). However, as a predictor of functional recovery, the role of strain rate imaging (SRI) is unknown. Method 21 patients with anterior AMI had transthoracic echocardiography to record CFV in the left anterior descending coronary artery at next day after successful primary coronary angioplasty (day 1) and at 1 week. Simultaneously, SRI was performed to obtain strain rate parameters at apical septum. Regional wall motion was estimated as anterior wall-motion score index (AWMSI) at day 1, 1 week and 6 month after the onset of AMI. Result Patients were divided into two groups: good wall-motion recovery group (group 1, AWMSI ��� 2.0 at 6 month) and poor wall-motion recovery group (group 2, AWMSI > 2.0 at 6 month). Age, ejection fraction on day 1, peak troponin T, onset to reperfusion time were not different in two groups, but peak creatine kinase levels were significantly increased in group 2 than in group 1 (5287 vs. 2609 U/L, p = 0.021). Deceleration time of diastolic CFV in group 1 was significantly longer than in group 2: 1178 vs. 534 ms on day 1, p = 0.031; 1416 vs. 812 ms on 1 week, p = 0.015. On SRI, the difference of strain rate parameters was not significant on day 1, but only peak systolic strain in group 1 was significantly lower than in group 2 on 1 week ( -9.2 % vs. -2.1 %, p = 0.011). For the prediction of functional recovery, peak systolic strain < -4.0% had a sensitivity of 88% and a specificity of 69% on 1 week. Conclusion SRI can predict the recovery of regional left ventricular function in anterior AMI, but the point of time for the prediction of functional recovery was later than that with CFV analysis.