Thallium myocardial imaging has been widely available for the detection of myocardial ischemia and assessment of myocardial viability in coronary artery diseases. However, myocardial imaging using SPECT and gamma-emitting radiopharmaceuticals has been developed for accurate evaluation of myocardial infarction and ischemia. The present study was undertaken to clinically evaluate myocardial necrosis, metabolism and sympathetic nerve activity. In this study, myocardial fatty acid metabolism was assessed using 123I-BMIPP, myocardial sympathetic neural activity was assessed using 123I-MIBG and myocardial necrosis was assessed using 111-In-antimyosin Fab. Dual energy SPECT using these new agents and thallium gives precise characterization of myocardial viability in coronary artery disease.