Impairment of LV diastolic filling is one of the earliest manifestations of acute myocardial infarction (AMI). Expressed in term of inverted E/A ratio and altered deceleration time (DT) using classic standard Doppler imaging, pts were shown to pursue a variable clinical course and outcome. The introduction of newer techniques for EchoCG evaluation of diastolic function, e.g. color M. mode and tissue Doppler imaging (TDI) has permitted earlier detection of various patterns of diastolic dysfunction (DD). The present work is intended to assess the various patterns of LV diastolic function in pts who have recently sustained AMI through the 3 modalities; transmitral Doppler, color M-mode and TDI. Forty two pts with AMI (35 M, 7 F, mean age 54± 9.7 yrs), constituted the material of the study. Myocardial infarction was anterior in 22, inferior in 16 and non Q in 4 patients. Following clinical evaluation -including 12-leads ECG, and standard laboratory measurements- all pts were subjected to: 1) Echocardiographic study comprising: a) Transthoracic conventional M-mode and 2D echo examination for obtaining the following measurements: left ventricular end diastolic volume (LVEDV), end systolic volume (LVESV), ejection fraction (EF) and LV wall motion score index (WMSI). b) standard transmitral Doppler indices of DD: (E, A, E/A ratio, isovolumic relaxation time IVRT and DT. c) Color M-mode Doppler: to measure propagation velocity (Vp) cm/sec and d) TDI: using pulsed wave Doppler to measure diastolic mitral annular velocities (Em, Am, Em/Am ratio and IVRT) at the different sites of the mitral annulus. Pts were followed up for an average period of 4 ±1.43 months, (range: 2.5 to 10 months). Using transmitral Doppler permitted segregation of our pts into 3 subsets: Normal DD (E/A > 1, DT: 140 – 220 ms) in 24 pts (57%), impaired relaxation (E/A < 1, IVRT > 100 sec, DT > 220 ms) in 8 patients (19%) and restrictive DD (DT < 140 ms, IVRT < 60 sec and E/A > 2) in 10 patients (24%). Color M-mode could divide the 24 pts with apparently normal LV diastolic filling into: truly normal (14 pts 33%) and pseudonormal DD (10 pts 24%). Application of TDI could segregate pts into 4 subgroups: normal, pseudonormal, impaired relaxation and restrictive filling patterns, thus confirming the filling pattern by the two modalities