Left ventricular wall motion was assessed in 105 consecutive patients both invasively, using biplane cineangiography, and noninvasively, by a real-time, phased-array, two-dimensional echocardiography system. Ventricular wall motion in five anatomic areas of the ventricle (anterolateral, posterolateral, apical, septal, and inferior) was analyzed by both methods in a double-blind manner. Two-dimensional echocardiographic images were deemed adequate for analysis in 82% of the regions (430 of 525). Fifty-five discrepancies were noted in the comparison of the remaining 430 regions. The reasons for discrepancies in interpretation between the two methods were established for 54 during retrospective review: 33 were due to echocardiography (inadequate target visualization, observer error, or tangential echo views). Fifteen were related to angiography (overlay of silhouettes or observer error), and six were due to other reasons including definition problems or spatial orientation difficulties. Both real-time, two-dimensional echocardiography and cineangiography have advantages and disadvantages. The techniques used together could provide more complete information concerning ventricular wall movement than is now currently available.