In an attempt to formulate a reliable noninvasive method of detecting segmental wall motion disturbances, we examined 25 patients with coronary artery disease by two-dimensional echocardiography (2-DE), standard 12-lead electrocardiography (ECG), and biplane left ventriculography. The 2-DE technic predicted qualitative wall motion abnormalities as defined by ventriculography with a sensitivity of 88% and a specificity of 86%. The ECG (Q waves) predicted segmental wall motion disturbances with only 50% and 51% sensitivity and specificity, respectively. Extrapolating the advantages of 2-DE to the assessment of global myocardial function, left ventricular wall motion index (LVWMI) and E-point septal separation (EPSS) by 2-DE were correlated with left ventriculographic ejection fractions; r values were high (.73 and -.76, respectively) in both instances. Thus, 2-DE provides a reliable noninvasive technic by which both regional and global myocardial wall motion disturbances can be assessed. Unlike previous noninvasive methods, the 2-DE results compared very favorably with those of biplane left ventriculography.