In this pilot study of 50 consecutive patients with prior myocardial infarction, the results of two-dimensional echocardiographic and angiographic analysis of wall motion abnormalities were correlated, and their prognostic significance was determined. There was overall good agreement (88%) between the two methods. In general, the greater the left ventricular dysfunction, the worse was the prognosis. The 3-year survival was significantly reduced for patients with a left ventricular wall motion score index of 2.5 or greater (P = 0.024). These findings were essentially similar to the reduced survival rate associated with decreased angiographic ejection fractions (less than 40%). This study suggests that two-dimensional echocardiography, a noninvasive and relatively inexpensive technique, can provide prognostic information in patients with prior myocardial infarction.