Background: Long-term effect of no-reflow evaluated by intravenous myocardial contrast echocardiography (IV-MCE) performed at the next day of primary percutaneous coronary intervention (pPCI) remains to be fully analyzed. Methods: IV-MCE was performed using PESDA at the next day of pPCI (D2) in 59 patients with anterior wall acute myocardial infarction. In 27 patients, diastolic peak velocity (Vpeak) and deceleration time (DT) of coronary blood flow were also measured at distal left anterior descending artery without inducing hyperemia using Doppler echocardiography at D2. Left ventricular end-systolic and end-diastolic volumes and ejection fraction (EF) were determined at D2 and followed up until 12짹9 months later (F/U). Results: No-reflow was detected in 22 patients and good reflow was in 37 patients. DT in no-reflow group (n=8) was significantly shorter than DT in reflow group (n=19) (189짹88 vs. 332짹161 msec, p<0.05), while Vpeak was not different between the two groups. At D2, no-reflow group showed significantly larger end-systolic volume (47짹10 vs. 38짹14 ml, p<0.05) and end-diastolic volume (94짹19 vs. 79짹21 ml, p<0.01) than reflow group, but EF was not different between the two groups (49짹8 vs. 52짹9 %, p=0.24). One patient with no-reflow died suddenly 6 days after pPCI. EF became significantly different between no-reflow and reflow groups in 7 days (47짹8 vs. 58짹9 %, p<0.005), and this difference persisted until F/U. Compared to D2, EF significantly improved at F/U in reflow group (57짹9 %, p<0.001), whereas it did not in no-reflow group (47짹6 %, p=0.22). End-systolic volume significantly increased in no-reflow group at F/U (64짹24 ml, p<0.005), whereas it did not in reflow group (42짹28 ml, p=0.35). End-diastolic volume significantly increased in both groups at F/U, but it was significantly larger in no-reflow group than in reflow group at F/U (118짹42 vs. 93짹33, p<0.05). Conclusions: No-reflow evaluated by IV-MCE at D2 of pPCI is associated with short DT, and useful to predict long-term left ventricular systolic function. EF improves mostly within a week after pPCI in patients with good reflow while long-term left ventricular remodeling persists in patients with no-reflow.