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Background: The effects of endovascular therapeutic hypothermia (ETH) in ST-elevation myocardial infarction (STEMI) regional contractility are unknown, and its impact on segmental contractility has still not been evaluated. We sought to evaluate segmental myocardial strain after ETH adjuvant to percutaneous coronary intervention (PCI) in STEMI., Methods: We included patients who underwent 1.5 T cardiac magnetic resonance exams 5 and 30 days after acute anterior or inferior STEMI in a previous randomized trial. Left ventricle (LV) strain was evaluated on infarcted, adjacent, and remote myocardium. Segmental circumferential (CS) and radial strains (RS) were measured using feature-tracking imaging. Repeated-measures of ANOVA was used for comparisons within time and treatment., Results: Forty patients were divided into hypothermia (ETH, n=29) and control (n=11) groups, with 5210 LV segments. In ETH infarcted areas, RS (11.2±16 vs. 14.8±15.2, p=0.001) and CS (-5.4±11.1 vs. -8±11.1, p=0.001) showed recovery from 5 to 30 days compared to controls (11.4±14 vs. 13.1±16.8, p=0.09; -6.5±10.6 vs. -6.4±12.5, p=0.94). In control remote areas, RS (28±18 vs. 31.7±18.5, p=0.001) and CS (-15.5±10.7 vs. -17.1±9, p=0.001) improved from 5 to 30 days compared to ETH (28.6±18.6 vs. 29±20, p=0.44; -15.2±10.4 vs. -15.3±10.6, p=0.82). Transmural infarcted areas in ETH improved RS (11.8±13.2 vs. 8.17±14.7, p=0.001) and CS (-6.1±10.9 vs. -3.1±11.3, p=0.001) compared to controls, with better contractility at 30 days., Conclusions: In anterior or inferior STEMI patients, ETH adjuvant to PCI is associated with significant improvement in RS and CS of infarcted areas, including transmural segments, but not in the remote area. This might further increase our pathophysiological knowledge on early LV remodeling and ultimately suggest potential clinical value., Availability of Data and Materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Lucas de Mello Queiroz reports financial support was provided by National Council for Scientific and Technological Development. Jose Carlos Nicolau reports financial support was provided by National Council for Scientific and Technological Development. Jose Carlos Nicolau reports a relationship with Amgen Inc that includes: funding grants. Jose Carlos Nicolau reports a relationship with AstraZeneca that includes: funding grants. Jose Carlos Nicolau reports a relationship with Bayer Corporation that includes: funding grants. Jose Carlos Nicolau reports a relationship with CSL Behring that includes: funding grants. Jose Carlos Nicolau reports a relationship with Daiichi Sankyo Inc that includes: funding grants. Jose Carlos Nicolau reports a relationship with DalCor Pharmaceuticals Canada Inc that includes: funding grants. Jose Carlos Nicolau reports a relationship with Esperion Therapeutics Inc that includes: funding grants. Jose Carlos Nicolau reports a relationship with Janssen Pharmaceuticals Inc that includes: funding grants. Jose Carlos Nicolau reports a relationship with Novartis that includes: funding grants. Jose Carlos Nicolau reports a relationship with Novo Nordisk that includes: funding grants. Jose Carlos Nicolau reports a relationship with Sanofi that includes: funding grants. Jose Carlos Nicolau reports a relationship with Vifor Pharma Switzerland SA that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Competing interests Sponsors or founders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation or review of the manuscript. JCN reports research grants from Amgen, AstraZeneca, Bayer, CSL Behring, Daiichi Sankyo, Dalcor, Esperion, Janssen, Novartis, Novo Nordisk, Sanofi and Vifor. No potential conflict of interest related to the present manuscript., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)