Objective：To explore the evaluation of myocardial microcirculation characteristics and predictive value for left ventricular remodeling in patients with myocardial infarction using three-dimensional speckle tracking imaging. Methods：A total of 165 patients with myocardial infarction admitted to Chest Hospital affiliated to Zhengzhou University from August 2020 to August 2023 were selected for the study. According to the increase rate of left ventricular end-diastolic volume index（ΔLVEDVI），the patients were divided into left ventricular remodeling group（ΔLVEDVI>20%，74 cases）and non-left ventricular remodeling group（ΔLVEDVI≤20%， 91 cases）. The predictive value of myocardial microcirculation characteristics for left ventricular remodeling in patients with myocardial infarction was evaluated using receiver operating characteristic（ROC）curve. The influencing factors of left ventricular remodeling in patients with myocardial infarction were screened by stepwise regression analysis. A risk prediction model for left ventricular remodeling in patients with myocardial infarction was established and validated. Results：Coronary intervention time，myocardial infarction area，C-reactive protein（CRP），matrix metalloproteinase-（9 MMP-9），vascular endothelial growth factor-A（VEGF-A），index of microcirculatory resistance（IMR），fractional flow reserve（FFR），and coronary flow reserve（CFR）were all independent risk factors affecting left ventricular remodeling in patients with myocardial infarction（P < 0.05）. The calibration curve results showed that the multivariate logistic regression model had good accuracy. Conclusion：Myocardial microcirculation characteristics in patients with myocardial infarction have certain predictive value for left ventricular remodeling.