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Aims: To evaluate the accuracy of longitudinal and transversal systolic strain using speckle tracking echocardiography in patients (pts) with ST-elevationmyocardial infarction (STEMI).Methods: Consecutive pts admitted with first-ever STEMI that underwent primary angioplasty (PCI) were studied. Standard Doppler echo and 2DSE were performed within 72 hours. Regional WM was scored by two operators and the final score was decided by consensus. In blinded post-processing, the longitudinal systolic strain and strain-rate, the transversal systolic strain and the protodiastolic strain-rate were measured. This parameters were compared with WMS using ANOVA and t-student tests (longitundinal systolic strain and strain-rate) and Kruskal-Wallis e Mann-Whitney (transversal systolic strain andprotodiastolic strain-rate). The accuracy of each parameter was assessed by the area under the Receiver Operator Curve (AUC).Results: We studied 176 pts with mean age of 63±14 years, 70% males. The culprit artery was the anterior descending in 43.6%, the circumflex 17.2% or the right coronary 39.7%. Among the 1463 myocardial segments evaluated, with regional WM abnormalities was present in 40% of the segments. Longitudinal systolic strainand strain-rate changed significantly with the WMS (p<0.001), being more negative in the normokinetic segments. Transversal systolic strain and protodiastolic strain-rate showed significantly lower values with the WMS (p<0.001). The parameter with best accuracy to evaluate regional wall motion abnormalities was the longitundinal systolic strain (AUC: 0,77; IC95%0,74-0,79; p<0,001), being more accurate in the apical segments.Conclusion: Myocardial deformation assessed by speckle tracking allows the quantifications of regional wall motion abnormalities in patients with STEMI, being the longitudinal systolic strain the parameter with best accuracy.