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Post-systolic motion (PSM) assessed by tissue velocity imaging (TVI) has been proposed as a marker for regional myocardial ischemia and dysfunction. The purpose of this study was to compare the regional distribution of PSM in patients after an ST-Segment elevation myocardial infarction (STEMI) with the presence of ≥50% transmural scar (SCAR), as identified by contrast enhanced magnetic resonance imaging (MRI).Methods & Results: We studied 22 consecutive patients (19 male, age 38-87 years) within 1 week with TVI and MRI after an acute STEMI in the anterior wall (ANT, LAD-territory n=10) or posterior/posterolateral wall (POST, LCX/RCA n=12). All patients underwent immediate percutaneous coronary intervention (PCI). In an 18-segment model(total 396 segments) we identified 89 (23%) segments with SCAR and 237 (60%) segments with PSM. 67% of all SCAR segments showed PSM, while in contrast PSM was also present in 58% of the healthy segments. Only 60 (15%) of all segments with PSM also showed SCAR. PMS was observed in 78% of all SCAR segments after ANT-STEMI, but only in 46% of all SCAR segments after POST-STEMI (p<0.001). In 86% of all SCAR segments after ANT-STEMI and in 89% of all SCAR Segments after POST-STEMI we found PSM in the healthy remote opposing wall.Conclusion: PSM is a frequent finding in patients after STEMI with SCAR. However, it is not a reliable marker for regional myocardial dysfunction in the interrogated segment and occurs frequently in healthy remote segments in the opposing wall. This can be explained by the complex intraventricular interaction and tethering effects. Longitudinal PSM by TVI is a marker for persistent SCAR after STEMI and may serve as a robust screening tool to identify patients at risk, but should not be interpreted as a marker for regional viability and function.