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Introduction: In this study, we aimed to evaluate the possibility of assessing cardiac abnormality using the left ventricular anatomical axis (LVAA) obtained from short-axis views of myocardial perfusion imaging (MPI). Methods: To obtain LVAA, an ellipse was drawn around the outer wall of SPECT images from XCAT phantoms and patients. The best line was then drawn from the center of all the ellipses in the short-axis views called LVAA. Then, we defined two angles based on LVAA including ɵ which is the angle created by LVAA with the x-axis, and Φ which is the angle created by LVAA with the z-axis Results: In this study, 94 cases were enrolled including 48 males (51%) and 46 females (49%) with a mean age of 65.65±10.04. According to the results, there was a significant difference between the two obtained angles and the result of the scan (p<0.05). The ideal cut-off of ɵ for an abnormal scan was 91.79 (AUC, 0.93; p=0.001) with the sensitivity of 98% and specificity of 80%. Conclusion: It can be concluded that LVAA as a quantitative factor is significantly different between normal and abnormal MPS and can be used for the evaluation of MPI. [ABSTRACT FROM AUTHOR]