The predictive value of the left ventricular spatial flow pattern for thrombus formation was determined in 62 patients with acute myocardial infarction. A normal flow pattern by pulsed Doppler echocardiography was characterized by 1) simultaneous onset of blood motion at the mitral valve and apical level, and 2) a discontinuous Doppler signal along the lateral wall and interventricular septum. The flow pattern was assessed by these criteria, within 24 h after the onset of complaints and after 6 and 12 weeks. In 46 of the 62 patients, a normal flow pattern was found at the first examination; none of these 46 patients developed a thrombus during the study period. An abnormal flow pattern was seen at the first examination in 16 patients; this pattern normalized during follow-up in 6 patients, none of whom developed a thrombus. In the other 10 patients the abnormal flow pattern persisted, and 7 of these developed a thrombus. These findings suggest that a normal left ventricular flow pattern in the setting of acute myocardial infarction is not associated with subsequent thrombus formation. This observation may be of importance if anticoagulation is considered.