Background: Left ventricular (LV) global torsion have been proposed as a non invasive and simple method that enables the evaluation of LV function. However, its use to predict complications after acute myocardial infarction (AMI) is not investigated. Therefore, the purpose of this study was to investigate LV torsion allows noninvasive prediction of complications with AMI. Methods: From Jan 2006 through June 2008, 171 consecutive patients with AMI were enrolled. Echocardiography images were measured before reperfusion therapy. Subsequent complications including cardiac death, shock, congestive heart failure, cardiac rupture, pericardial effusion and LV aneurysm during the 30 days after the onset of AMI were prospectively evaluated. Results: Complications were developed in 38 of 171 patients with AMI. Global torsion was significantly decreased in patients who developed complications compared with those without them (Table). In multivariate analysis, higher Killip classification [HR 3.07 (1.67-15.19)] and low torsion [HR 6.14 (2.47-15.21)] were significant predictors of acute complications. Using receiver operating characteristic analysis, optimal cutoff value of 1.7 cm/deg for LV torsion was chosen the predict acute complications (sensitivity = 80.5 %, specificity = 73.7 %, AUC=0.797). Conclusion: In patients with AMI, speckle tracking imaging analysis at initial presentation allows noninvasive prediction of subsequent complications.