Reports have indicated that myocardial accumulation of ^99mTc-pyrophosphate occurs in the absence of a recent myocardial infarction. An attempt was made to determine if myocardial accumulation, in the absence of a recent infarction, may be associated with left ventricular wall motion abnormalities. 51 patients undergoing elective left ventriculography had ^99mTc-pyrophosphate cardiac scans 24–28 h prior to the procedure. 33 (33/51) patients had myocardial accumulation; all 33 had left ventricular wall motion abnormalities. Localized myocardial accumulation occurred in 21 (21/33) patients; 19 of the 21 had localized left ventricular wall motion abnormalities corresponding to the area of myocardial accumulation. 12 (12/33) patients had diffuse myocardial accumulation; 4 had diffuse left ventricular hypokinesis and 8 had localized myocardial dysfunction. 18 (18/51) patients had no myocardial accumulation of the radionuclide; 9 had normal wall motion in all areas and 9 had localized dysfunction. The data strongly suggest that myocardial accumulation of ^99mTc-pyrophosphate in the absence of a recent myocardial infarction is associated with a left ventricular wall motion abnormality.