The clinical significance of the paradoxical mismatched phenomenon between Tl-201 and I-123-BMIPP is still unknown. We report two cases that revealed paradoxical regional myocardial uptake between two tracers in patients with cardiomyopathy. There may be abnormal myocardium in these patients where active transportation of Tl-201 is disturbed and passive transportation of I-123-BMIPP is not disordered.