Determination of systolic thickening index with gated Tc-99m sestamibi SPECT - A new parameter of myocardial viability?

Myocardial perfusion imaging with Tc-99m MIBI SPECT may underestimate the amount of viable myocardium in patients with coronary artery disease and prior infarction. Electrocardiogram gating could potentially better correlate with the presence of jeopardized myocardium, since it allows the evaluation of systolic contractility parameters in addition to the assessment of perfusion. Using the diastolic and systolic bull's eyes of a rest Tc-99m MIBI-gated SPECT study to generate an index of systolic thickening, we clearly observed an impaired contractility in the anterior and septal walls in a patient with multiple vessel disease and a mild mid-left anterior descending stenosis, despite a normal tracer uptake. Confirmation of the index of systolic thickening findings was obtained by rest/redistribution TI-201 SPECT, showing decreased anteroseptal perfusion on the early images with almost complete perfusion. Gating myocardial perfusion imaging seems helpful to identify myocardium at risk. It can aid in the evaluation of the physiological significance of mild coronary artery disease, sometimes insufficient to result in perceptible flow disturbances but already responsible for contractility abnormalities, especially when a large arterial territory is involved.