The differentiation of residual viability from necrotic myocardium in patients with a previously sustained myocardial infarction is important in deciding indications for revascularization. Myocardial viability can be assessed by studying perfusion and regional wall motion. With gated single photon emission computed tomography (SPECT), it is possible to augment SPECT perfusion data with ventricular functional data both at a global and regional level. The aim of the study was to analyse the concordance between wall motion score derived by gated SPECT and echocardiography. Furthermore, the agreement between myocardial perfusion and left ventricular wall motion was analysed with both techniques. We studied a homogenous group of 25 consecutive patients with a previous myocardial infarction (MI) using both gated SPECT 99Tcm-tetrofosmin myocardial perfusion imaging and two-dimensional echocardiography. Echocardiography was performed within 2 weeks of the gated SPECT study. Both for gated SPECT and for echocardiography the left ventricle was divided into seven regions per patient. For comparison, the gated SPECT regions were matched to the echocardiographic regions, resulting in a total of 175 regions. Prevalence of abnormal wall motion (akinetic or dyskinetic) was 23% (39/171) for echocardiography and 21% (36/175) for gated SPECT (P = NS). There was a high agreement in wall motion score between echocardiography and gated SPECT of 80% (136/171). The agreement between myocardial perfusion and myocardial wall motion was 82% (143/175) for gated SPECT and 76% (130/171) for echocardiography (P = NS). Nineteen (34%) of the 56 regions with severely diminished or absent myocardial perfusion showed normal or hypokinetic wall motion both by gated SPECT and echocardiography suggesting residual myocardial viability in malperfused regions. Our results suggest that, gated SPECT imaging is a reliable tool for the assessment of regional wall motion in post myocardial infarction patients. Furthermore, in patients with a previous myocardial infarction gated SPECT imaging has the potential to detect preserved wall motion in regions with fixed perfusion defects, which might be indicative of residual myocardial viability.