In this case, the authors present a patient with heart failure who undergoes cardiac resynchronisation therapy (CRT) and shows clinical improvement with marked left ventricular (LV) reverse remodelling. The authors describe their use of a software programme to process perfusion imaging data recorded with ECG-gated single-photon emission computed tomography as a new method for analysing LV dyssynchrony in patients who have received CRT; images provided. The authors suggest that discordance of systole in regional myocardial segments may present as mechanical dyssynchrony in the LV and could be used as an alternative to QRS duration and that quantitative assessment of dyssynchrony may be possible using this novel method.