BACKGROUND: The ratio of early transmitral flow velocity to early diastolic velocity of mitral annulus (E/E���) has been considered as a noninvasive standard measurement for estimating the left ventricular filling pressure (LVFP). However, there has been few data on diagnostic utility of E/E��� in the presence of regional wall motion abnormalities (RWMA) after myocardial infarction (MI). We assessed the usefulness of E/E��� measured at the mitral annulus adjacent to the segment with RWMA for the estimation of LVFP. METHODS: We studied 135 patients (104 male, mean age 60짹12 years) with RWMA after MI. By echocardiography, left ventricular regional wall motion was evaluated and E/E��� at septal and lateral mitral annulus (septal E/E���, lateral E/E���) were measured using tissue Doppler imaging (TDI). Within 6 hours after echocardiographic measurements, all patients underwent cardiac catheterization to investigate the left ventricular end-diastolic pressures (LVEDP). We classified the patients without RWMA of basal septum and lateral segment as group A (n = 86), the patients with RWMA of basal septum and normal wall motion of basal lateral segment as group B (n = 27) and the patients with RWMA of basal lateral segment and normal wall motion of basal septum as group C (n = 17). RESULTS: In all studied patients, both septal and lateral E/E��� positively correlated with LVEDP (septal E/E���; r = 0.325, p < 0.001, lateral E/E���; r = 0.372, p < 0.001). In subgroup analysis, septal E/E��� showed significant correlation with LVEDP in group A and C (group A; r = 0.250, p = 0.020, group C; r = 0.615, p = 0.009), whereas lateral E/E��� significantly correlated with LVEDP in all three groups (group A; r = 0.321, p = 0.003, group B; r = 0.455, p = 0.020, group C; r = 0.623, p = 0.008 ). CONCLUSIONS: In conclusion, echocardiographic measurement of E/E��� by TDI is a useful method for the assessment of LVEDP in patients with RWMA after MI. However, in selected patients with RWMA of basal septum or lateral segment, lateral E/E��� showed good correlation with LVEDP regardless of RWMA of basal septum or basal lateral segment in patients with MI.