Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

Normal myocardial perfusion scan and myocardial stunning phenomenon in three vessel coronary artery disease

Document Type : Case report

Authors
Arash Gholoobi 1
Vahid Reza Dabbagh 2
Ramin Sadeghi 2
Somayeh Ghahremani 3
1 Cardiovascular Department, Imam Reza Hospital, Mashhad University of Medical Sciences
2 Nuclear Medicine Research Center, Ghaem Hospital, Mashhad University of Medical Sciences
3 Jawadalaime Hospital, Mashhad, Iran
10.22038/mjms.2026.91588.5134
Abstract
Background: Detecting multivessel coronary artery disease, especially the condition of balanced ischemia, remains a major challenge in myocardial perfusion imaging with SPECT. In this report, we present a case in which nearly normal perfusion but a marked post-stress decline in LVEF led to the diagnosis of balanced triple-vessel disease.
Case Presentation: A 65-year-old man with a history of diabetes and hypertension presented with chest pain. Myocardial perfusion gated SPECT showed a mild basal anterolateral ischemia, but gated-SPECT functional analysis revealed an LVEF of 55% at rest and 44% on post-stress images. This significant stress-induced myocardial stunning prompted invasive coronary angiography, which confirmed severe triple-vessel disease.
Conclusion: In patients with a high likelihood of coronary artery disease, even when perfusion images appear nearly normal, a post-stress reduction in LVEF should be considered a warning sign. Integrating perfusion and functional data—particularly stress-induced LVEF decline—can help reduce false negatives in the diagnosis of triple-vessel disease.
Keywords
Gated SPECT
PET
Myocardial Stunning
Balanced Three Vessel Disease
myocardial perfiusion SPECT
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Medical Journal of Mashhad university of Medical Sciences
Volume 69, Issue 2
May 2026
Pages 206-212