Left ventricular ejection fraction (LVEF) and wall thickening are fundamental aspects of cardiac function. Recently, gated single photon emission computerised tomography (GSPECT) and anatomical M-mode echocardiography are new techniques, which have been introduced for the evaluation of left ventricular wall thickening and ejection fraction. These, however, have not been evaluated against established techniques, including equilibrium radionuclide ventriculography (ERNV), which remains the current gold standard for the evaluation of LVEF. We examined the concordance between LVEF, wall motion and wall thickening scores derived from GSPECT, echocardiography and ERNV, in a group of 16 patients with suspected ischaemic heart disease. Estimated ejection fraction correlated better between ERNV and gated SPECT (R2 = 0.93) than between echocardiography and either gated SPECT (R2 = 0.62) or ERNV (R2 = 0.71). There was poor correlation between gated SPECT and anatomical M-mode echocardiography in the assessment of wall thickening (83/150, 56%; kappa= 0.31, p < 0.05) and similar correlation (100/150, 66%; kappa = 0.29, p < 0.01) for wall motion analysis. In conclusion, estimations of ejection fraction by all the three studied modalities agreed to a degree sufficient for routine clinical practice. However, estimates of wall thickening from echocardiography cannot be used interchangeably with those derived from gated myocardial perfusion SPECT.