Purpose: The purpose of the present study is to investigate which enhancement pattern of two-phase contrast-enhanced multidetector computed tomography (MDCT) in reperfused acute myocardial infarct (AMI) predicts improvement of left ventricular function. Methods: First-onset AMI patients were enrolled. After successful revascularization, two-Phase Contrast enhanced MDCT was taken within 3 days after revascularization. The patterns of perfusion defects and late enhancement (LE) were classified into three groups. Group A = absence of early perfusion defect (ED) and absence or presence of LE without residual perfusion defect (RD), group B = presence of ED and presence of LE without RD, group C = presence of ED and presence of LE with RD. Echocardiogram was taken within 12 hours and 6 months after revascularization. Regional wall motion improvement was analyzed in each infracted segment using 17-segment model. Results: Fifty-three AMI patients and 247 infarcted segments (group A, 45; group B, 82; Group, C; 120) were enrolled. Akinetic, hypokinetic and normal wall motion segments were 6(13%), 9(20%) and 30(67%) in group A, 51(63%), 29(35%) and 2(2%) in group B, 96(80%), 24(20%) and 0(0%) in group C respectively in initial echocardiogram. Akinetic segment was the most frequent in group C in initial echocardiogram (p=0.045). In group A, wall motion was completely normalized at 6 moth follow-up. At 6 month follow-up, wall motion improvement was more frequent in group B than in group C (28(45%) vs. 8(7%);p=0.003) and wall motion worsening was more frequent in group C (2(3%) vs. 13(11%);p=0.012) than in group B. Conclusions: RD in the delayed phase of two-phase contrast enhanced MDCT corresponded to worse left ventricular function improvement than LE. RD can be assumed to have greater myocardial damage than LE.