Background: One of the main risk factors for coronary artery disease (CAD) is diabetes mellitus. The myocardial wall function can be objectively analyzed with tissue Doppler imaging (TDI) echocardiography, which can also provide insight into the genesis of heart illness. The aim of this study was to investigate the predictive potential of myocardial blush grade and the tissue Doppler echocardiography-measured E/(e'×s') ratio for left ventricular remodeling in patients with type 2 diabetes who had received primary percutaneous intervention for a ST segment elevation myocardial infarction. Methods: A total of one hundred patients with ST-elevation myocardial infarction (STEMI) who were admitted to the cardiology department of Zagazig University Hospitals participated in this prospective study; fifty of them had diabetes, while the other fifty did not. The septal, lateral, average early diastolic (e'), peak systolic (s'), and tissue Doppler mitral annulus velocities were measured. Using visual assessment procedures, two experienced interventional cardiologists were trained to determine the Myocardial blush grade (MBG) and TIMI flow score while being blinded to the data. Results: Individuals with a greater E/(e'×s') ratio had a lower LVEF and a bigger LA volume both at baseline and during follow-up. Myocardial blush grade and LV dysfunction (systolic and diastolic) were independently predicted by ST segment resolution, WMSI, and E/(e'×s') ratio. Conclusion: In patients with type 2 uncontrolled diabetes, the TDI E/(e'×s') is a quick and easy way to measure LV diastolic and systolic dysfunction. In these individuals, it might be used to forecast heart failure