OBJECTIVE This study attempted to determine the optimal interpretation method of intravenous myocardial contrast echocardiography (MCE) for predicting myocardial functional recovery in patients with acute myocardial infarction. BACKGROUND Assessment of the myocardial contrast effect is subjective and there is currently no universal agreement on the pulsing interval (PI) for imaging. METHODS Twenty-nine patients underwent percutaneous transluminal coronary angioplasty (PTCA) 4.8 +/- 1.9 days after acute myocardial infarction and intravenous MCE before and 24 hours after PTCA by using intermittent harmonic angioimaging at a series of PIs of 4, 8, 12, and 16 cardiac cycles. Adequate contrast enhancement was defined by homogeneous (MCEhomo score) and heterogeneous patterns (MCEheter score), and by a combination of intensity threshold and computed planimetry (MCEcom score). Adequate contrast enhancement at a shorter PI defined a higher MCE score (1 vs 5). The regional wall motion in the risk area was assessed before PTCA and 2 months after PTCA to evaluate functional recovery. RESULTS A significant improvement after PTCA was noted in the MCEhomo score (3.2 +/- 1.7 vs 3.6 +/- 1.7, P =.008) and the MCEcom score (2.9 +/- 1.6 vs 3.3 +/- 1.5, P <.0001), but not in the MCEheter score (4.3 +/- 1.3 vs 4.5 +/- 1.1, P =.058). Twenty-four hours after PTCA, segments with functional recovery had a higher MCEheter score (4.9 +/- 0.5 vs 3.8 +/- 1.6, P =.002), MCEhomo score (4.2 +/- 1.4 vs 2.6 +/- 1.9, P <.0001), and MCEcom score (3.8 +/- 1.2 vs 2.1 +/- 1.4, P <.0001) than those without. For the prediction of function recovery, MCEheter generally had a higher sensitivity but a lower specificity and accuracy than did MCEhomo and MCEcom. MCEcom had the best accuracy (83%) with a sensitivity of 95% and specificity of 61% at a PI of 16 cardiac cycles. CONCLUSION Using a combination of intensity threshold and computed planimetry for interpreting myocardial contrast enhancement at a long PI can optimize the value of MCE in predicting functional recovery after PTCA in patients with acute myocardial infarction.