Aim To identify early predictors for progression of chronic heart failure (CHF) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods The study included 113 patients with STEMI aged 52 (95 % confidence interval, 36 to 65) years. 24-h ECG monitoring was performed with assessment of ventricular late potentials, QT dispersion, heart rhythm turbulence (HRT), and heart rhythm variability (HRV); XStrain 2D echocardiograpy with determination of volumetric parameters, myocardial strain characteristics and velocities; and measurement of brain natriuretic peptide (BNP) concentrations. The endpoint was CHF progression during 48 weeks of follow-up, which was observed in 26 (23 %) patients. Based on the outcome, two groups were isolated, with CHF progression (Prg) (26(23%)) and with a relatively stable CHF postinfarction course (Stb) (87 (77 %)).Results At 12 weeks following MI, the Prg group showed increases in left ventricular (LV) end-diastolic dimension (EDD) (small er, Cyrillic<0.05) and end-diastolic and end-systolic volumes (EDV, ESV), (small er, Cyrillic<0.01), and EDV and ESV indexes (EDVi and ESVi, small er, Cyrillic<0.01). In this group, global longitudinal strain (GLS) was decreased at 24 weeks (small er, Cyrillic<0.05) and global radial strain (GRS) was decreased at 48 weeks (small er, Cyrillic=0.0003). In the Prg group, values of strain parameters (GLS, global circular strain (GCS), and GRS) were lower at all times. At 7-9 days, 24 weeks, and 48 weeks, the proportion of patients with pathological HRT was higher in the Prg group (38, 27, and 19 % for the Prg group vs 14 % (small er, Cyrillic=0.006); 3,4 % (small er, Cyrillic=0.001), and 2.3 % (small er, Cyrillic=0.002) for the Stb group, respectively). Only in the Stb group, increases in HRV were observed (SDNNi by 13 % (small er, Cyrillic=0.001), rMSSD by 24 % (small er, Cyrillic=0.0002), TotP by 49 % (small er, Cyrillic=0.00002), VLfP by 23 % (small er, Cyrillic=0.003), LfP by 22 % (small er, Cyrillic=0.008), and HfP by 77 % (small er, Cyrillic=0.002). At 7-9 days of MI, the Stb group had greater values of SDANN (small er, Cyrillic=0.013) and HfP (small er, Cyrillic=0.01). CHF progression correlated with abnormal values of turbulence onset (TO), disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. Combined assessment of HRT, LV ESD, and GLS at 7-9 days after STEMI allows identifying patients with high risk for CHF progression in the next 48 weeks.Conclusion The markers for CHF progression after STEMI include abnormal TO values, disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. The multifactor logistic regression analysis revealed early predictors of CHF in the postinfarction period, including abnormal TO, increased LV ESD, and reduced GLS.