BACKGROUND This study assesses the feasibility of 99mTc-labeled sestamibi electrocardiographic gated single-photon emission computed tomography (SPECT) with a short acquisition time (6.7 minutes, "fast" gated SPECT) for the evaluation of stress myocardial perfusion and poststress myocardial function. Simultaneous assessment of stress perfusion and poststress function is possible with standard gated SPECT acquisition (19.3 minutes) of stress-injected sestamibi. Sestamibi gated SPECT can be used to evaluate regional wall motion (RWM), thickening, and left ventricular ejection fraction (LVEF); the feasibility of fast gated SPECT has not been evaluated previously. RESULTS Fifty patients were studied who underwent treadmill exercise, sestamibi injection (25 to 30 mCi), and standard gated SPECT 15 minutes after exercise, immediately followed by fast gated SPECT. All patients underwent rest 201Tl SPECT before exercise testing. All studies were analyzed by semiquantitative visual scoring. Both standard and fast gated SPECT were read for stress perfusion and poststress wall motion and thickening, dividing the left ventricle into 20 segments, on a 5-point scale described previously. The measurement of LVEF used a previously described automatic algorithm. Average myocardial counts per pixel were 58 +/- 19 for standard gated SPECT and 13 +/- 4 for fast gated SPECT (p = 0.0001). Heart/lung ratio was 10.2 +/- 4.8 for regular gated SPECT and 10.3 +/- 5.7 for fast gated SPECT (difference not significant). Perfusion analysis showed exact agreement in 92% of the segments (kappa = 0.76; p < 0.01). Correlation between LVEFs measured from standard and fast gated SPECT was 0.94. Analysis of 998 segments (two segments were uninterpretable) showed exact agreement in 96% (kappa = 0.89; p < 0.001) for RWM and 94% (kappa = 0.83; p < 0.001) for thickening between standard and fast gated SPECT. In 225 segments with abnormal RWM and 189 segments with abnormal thickening by both standard and fast gated SPECT, exact agreements were 0.92 for RWM (kappa = 0.90; p < 0.001) and 0.87 for thickening (kappa = 0.80; p < 0.01). CONCLUSIONS Our data demonstrate that fast sestamibi gated SPECT is feasible and yields results equivalent to those of standard sestamibi gated SPECT with respect to left ventricular regional and global function.