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Figure 1 A, Rest and 4-h SPECT thallium images in a woman with severe two-vessel disease and severe LV dysfunction (EF 21%). There are severe diffuse wall motion abnormalities. The SPECT images are shown in the short-axis (apex to base, rows 1 and 3), vertical long-axis (septum to lateral wall, row 5) and horizontal long-axis projections (inferior wall to septum, row 7). The corresponding 4-h redistribution images are shown in rows 2, 4, 6 and 8 in the same orientations. There is only a mild perfusion defect involving the septum. B, Dobutamine sestamibi and rest thallium SPECT images from the same patient using the same format as in A. Here the sestamibi images are displayed in rows 1, 3, 5 and 7, and the rest thallium images in rows 2, 4, 6 and 8. There are now multiple reversible perfusion defects with transient LV dilation. This patient has a substantial amount of viable myocardium, and the LV dysfunction is secondary to myocardial stunning, hibernation and remodeling.
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