Recent advances in gated SPECT (G-SPECT) procedures for simultaneous quantitative analysis of perfusion and function have facilitated the clinical use for assessment of inducible ischemia, viability, and event risks in patients with known or suspected coronary artery disease. G-SPECT functional information can incrementally improve diagnostic powers of clinical information and stress SPECT perfusion data for risk-stratification of patients into low- and high-risk categories. The application of G-SPECT has been extended from asymptomatic patients at clinically high risk for cardiac disease to patients with advanced heart failure with left ventricular dyssynchrony. Clinical outcomes predicted by G-SPECT variables include not only cardiac death and nonfatal myocardial infarction but also de novo heart failure or heart failure requiring cardiac resynchronization therapy. Thus, a G-SPECT approach can contribute to better risk-stratification and to appropriate selection of prophylactic or therapeutic strategy in a cost-effective manner in patients at an increased risk for future cardiac events.