Background. The aim of this study is to show whether the septal E/(E' x S') ratio assessed by tissue Doppler echocardiography can predict left ventricular remodeling after first ST segment elevation myocardial infarction treated successfully with primary percutaneous intervention. Methods. Consecutive patients (n = 111) presenting with acute anterior myocardial infarction for the first time in their life were enrolled. All patients underwent successful primary percutaneous coronary intervention. Standard and tissue Doppler echocardiography were performed in the first 24-36 hours of admission. Echocardiographic examination was repeated after 6 months to reassess left ventricular volumes. Septal E/(E' x S') ratio was assessed by pulsed Doppler echocardiography. Results. Group 1 consisted of 33 patients with left ventricular (LV) remodeling, and Group 2 had 78 patients without LV remodeling E/(E' x S') was significantly higher in Group 1 (4.1 +/- 1.9 versus 1.65 +/- 1.32, p = 0.001). The optimal cutoff value for E/(E' x S') ratio was 2.34 with 87.0% sensitivity and 82.1% specificity. Conclusion. Septal E/(E' x S') values measured after the acute anterior myocardial infarction can strongly predict LV remodeling in the 6-month follow-up. In the risk assessment, the septal E/(E' x S') can be evaluated together with the conventional echocardiographic techniques.