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Stress myocardial perfusion scintigraphy has been one of the sensitive modalities to diagnose inducible ischemia. Theoretically one of the major pitfalls quoted is the lack of sensitivity in triple vessel disease due to balanced hypoperfusion. The aim of this investigation is to evaluate the efficacy of Gated Stress Myocardial Perfusion (MPI) SPECT in known patient of Triple Vessel Disease (TVD). Materials and Methods: 34 patients of known TVD were subjected to single day Gated stress MPI using Tc99m sestamibi. Results: Out of 34 patients perfusion abnormalities were detected in 31 patients (91.2%). Twenty-three of them (67.6%) had the defect in the territory of LAD, 11 (32%) in LCX and 25 (73.5%) in RCA. Transient Ischemic Dilatation (TID) was found in 24 patients (70 %) associated with perfusion defect. One out of three patients with normal perfusion showed TID .False Negative rate for hemodynamically significant coronary artery stenosis if only perfusion defects are evaluated is 2.94%. Management decision changed in 11 patients out of 34 patients (32.3%). With increase in the percentage of coronary stenosis there is increase in probability of occurance of perusion defects on myocardial perfusion scan. Conclusion: This study showed that combined assessment of perfusion patterns and gated SPECT help in risk stratification, TID can help in TVD with balance ischemia, However it is commonly associated with perfusion defects.

Stress Myocardial Perfusion Scintigraphy in Triple Vessel Disease – Role of TID in Balanced ischemia