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Purpose: To assess the usefulness of Speckle Tracking Echocardiography (STE) derived Automated Function Imaging (AFI) in distinguishing mono- and multi-vessel disease in patients referring at coronary care unit (CCU) for ST-segment elevation myocardial infarction (STEMI).Methods: The study population included 31 patients referring because of acute STEMI at CCU and 30 age-matched controls (C) with normal coronary angiography. In the same day all the participants underwent sequentially a complete echo-Doppler examination and coronary angiography. Echo-Doppler included also the evaluation by AFI, a software which utilizes STE principles by simple recording of 2-D imaging (> 40 fps) to quantify global and regional left ventricular (LV) longitudinal function. Peak longitudinal regional strain was measured at the 18 LV segments obtained in the 3 apical views and global longitudinal strain (GLS) calculated as the average of measurements. Strain of LV basal segments (average of 6 basal segments, BLS), middle segments (average of 6 mid segments, MLS) and apical segments (average of 6 apical segments, ALS) was also determined.Results: The 2 groups were comparable for body mass index, diastolic blood pressure and heart rate while systolic blood pressure was lower in STEMI group (p<0.01). STEMI patients had higher wall motion score index (WMSI) (p<0.0001) and E/e' ratio (p<0.01) and lower ejection fraction (EF) (p<0.0001). GLS, BLS, MLS and ALS were lower in STEMI than in C (all p<0.0001). In a subanalysis performed in STEMI group according to the number of stenotic coronary vessels derived from angiography, multivessel patients (n=14) showed in comparison with mono-vessels (n=17) lower GLS (-12 ± 3% vs. 14 ± 3%, p<0.05) and BLS (-11 ± 4% vs. -14 ± 4%, p<0.01) while MLS and ALS did not differ significantly between the 2 subgroups. EF, WMSI and E/e' ratio did not differentiate patients with mono- and multi-vessel disease. In the pooled population GLS, MLS and ALS were significantly related to EF and WMSI while BLS did not (EF: r = 0.27; WMSI: r = -0.29, both NS).Conclusions: AFI is clinically useful at bedside of patients referring for STEMI. The simple quantification of LV longitudinal basal myocardial levels may be useful to identify the number of vessels which are responsible of STEMI, providing information not obtainable by standard echocardiographic parameters of LV systolic function.