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

Document Type : Case report

Authors

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

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

References

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Medical Journal of Mashhad university of Medical Sciences
Volume 69, Issue 2
May 2026
Pages 203-209

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