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Backgrounds: During isovolumic contraction(IVC) phase, transitional counterdirectional deformations occur. This is because IVC starts along the subendocardial myocardium. Our purpose was to test the hypothesis that the presence of initial clockwise rotation of LV apex during IVC phase(RotIVC) is associated with myocardial transmurality and functional recovery in patients with acute anterior myocardial infarction(AMI).Methods: Thirty-six subjects were enrolled(24 patients with first episode of ST-segment elevation AMI, and 12 age-matched controls). AMI patients were selected prospectively who had successful primary PCI on the LAD only and showed akinetic apical segments and normal basal segments. Two-dimensional speckle tracking and cardiac magnetic resonance imaging were performed. The LV basal and apical rotation and LV twist were obtained. The presence of RotIVC of LV apex was determined. Quantification of transmural extent of delayed enhancement(DE) was assessed by <50% and ≥50% myocardial wall thickness. Myocardial functional recovery was defined as improved wall motion at 6-month follow-up.Results: Thirteen patients showed recovery and 11 patients showed no recovery. There was no significant difference of LV rotation and twist between patients with recovery and patients with no recovery. All controls showed RotIVC. Eleven of 13 patients with recovery, but none of 11 patients with no recovery showed RotIVC. Eleven of 12 patients with DE<50% and one of 12 patients with DE≥50% showed RotIVC. For prediction of myocardial functional recovery, the presence of RotIVC had sensitivity and specificity of 92% and 83%, respectively.Conclusion: The presence of RotIVC is related to the myocardial transmurality and thus can provide information regarding functional recovery in patients with AMI.