Objective Exploring the evaluation of myocardial microcirculation characteristics in patients with myocardial infarction using three-dimensional speckle tracking technology and its predictive value for left ventricular remodeling. Methods We will study 165 patients with myocardial infarction admitted to our hospital from August 2020 to August 2023. According to the increase rate of left ventricular end-diastolic volume index (△ LVEDVI), patients were divided into left ventricular remodeling group (△LVEDVI >20%, 74 cases) and non left ventricular remodeling group (△LVEDVI ≤ 20%, 91 cases). Evaluate the predictive value of myocardial microcirculation characteristics on left ventricular remodeling in patients with myocardial infarction through the receiver operating characteristic (ROC) curve. Screening the influencing factors of left ventricular remodeling in patients with myocardial infarction through stepwise regression analysis. Establish a risk prediction model for left ventricular remodeling in patients with myocardial infarction and validate it. Results The characteristics of myocardial microcirculation in patients with myocardial infarction have certain predictive value for left ventricular remodeling, and the combined detection of various indicators has higher predictive value. Coronary intervention time, myocardial infarction area, CRP, MMP-9, VEGF-A, IMR, FFR, and CFR are all independent risk factors affecting left ventricular remodeling in patients with myocardial infarction (P<0.05). The calibration curve results show that the multivariate logistic regression model has good accuracy. Conclusion The characteristics of myocardial microcirculation in patients with myocardial infarction have certain predictive value for left ventricular remodeling. Coronary intervention time, myocardial infarction area, CRP, MMP-9, VEGF-A, IMR, FFR, and CFR are all independent risk factors affecting left ventricular remodeling in patients with myocardial infarction.