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Aim: The objective of this study was to assess the usefulness of real time three dimensional (3D) echocardiography in early phase after an acute myocardial (AMI) to assess left ventricular (LV) volume and shape and to predict late LV remodeling.Methods: Seventy five patients with anterior AMI, treated with percutaneous coronary intervention (PCI), were studied. Standard 2- dimensional and 3D echocardiography were performed within 24 h after PCI and 12 months after AMI, by using a Vivid 7 Dimension (GE Vingmed Ultrasound, Horten, Norway). 3D echocardiographic data of left ventricle were obtained from the apical 4-chamber view. A series of 4 sub-volumes of left ventricle were acquired from 4 ECG-triggered cardiac cycles and then automatically integrated into an entire pyramidal dataset. All echocardiographic acquisitions were digitally stored for off-line analysis. Measurements of LV volume were performed with use of LV analysis software (Tom Tec Imaging Systems, Germany). LV conic index was calculated by dividing LV end-diastolic volume (EDV) by the volume of a cone whose bottom diameter is the internal diameter of the mitral annulus and height is the LV long axis. LV remodeling was defined as a > 20% increase from baseline in LV EDV at 12 months.Results: 3D echocardiography was feasible in all patients. Twenty four patients (32%) exhibited LV remodeling at follow up. At baseline, patients with LV remodeling showed greater LVEDV (p<0.05), wall motion score index, and E/E' ratio (p<0.01) and lower LV ejection fraction and mitral E wave deceleration time (p<0.05). The values of LV conic index were 5.4 ± 0.6 and 4.3 ± 0.5, respectively(p<0.001, patients with versus those without LV remodeling). Univariate and multivariate logistic regression analysis with automatic stepwise selection procedure and backward delimitation were performed to evaluate the relation between echocardiographic variables and the occurrence of LV remodeling. LV conic index added incremental prognostic values to LV EDV, ejection fraction, wall motion score index, E deceleration time and E/E'.Conclusion : The results of the present study indicate that real time 3D echocardiography is feasible in the setting of AMI and suggest that LV conic index can accurately predict LV remodeling after anterior wall AMI.