BACKGROUND AND OBJECTIVES: The relationship between the coronary artery flow velocity pattern on the distal left anterior descending coronary artery (LAD), using transthoracic Doppler echocardiography (TTE) and myocardial recovery, following an acute myocardial infarction (MI), has not been studied. SUBJECTS AND METHODS: The coronary flow velocity at the distal LAD was recorded with TTE, immediately, on the 7th day, and at an average, on the 10th month, in 36 patients following an acute anterior MI. The peak diastolic coronary flow velocity (PDV), the initial velocity pattern and alteration in the velocity pattern, during the follow-up period, were analyzed by the changes in the left ventricular systolic function and the anterior apical wall motion. The subjects were divided into two groups: the recovery (R) group:n=24, M:F=14:10, mean age=60+/-9 yrs;and the non-recovery (NR) group:n=12, M:F=11:1, mean age=61+/-11 yrs, according to their myocardial recovery status. RESULTS: The early flow velocity at the distal LAD, using TTE after MI, was divided into 4 patterns;a normal biphasic flow pattern, with a larger diastolic and a smaller systolic component; a pattern, with slow flow and deceleration slope;a pattern, with a retrograde flow; and a pattern, with a rapid diastolic deceleration slope and an early systolic reversal flow. A normal biphasic flow pattern was observed in 16 (66%) of the R-group (n=24), and 1 (8%) of the NR-group (n=12) (p=0.001) patients. A rapid diastolic deceleration slope and an early systolic reversal flow pattern was only observed in 4 of the NR-group (n=12) (p=0.003) patients. CONCLUSION: The patterns, with a rapid diastolic deceleration slope and a systolic retrograde flow, early after MI, and a persistent slow flow velocity during follow up, are related to poor myocardial recovery following an acute anterior MI.