We propose a novel spatiotemporal constraint based on shape and appearance and combine it with a level-set deformable model for left ventricle (LV) segmentation in four-dimensional gated cardiac SPECT, particularly in the presence of perfusion defects. The model incorporates appearance and shape information into a ‘soft-to-hard’ probabilistic constraint, and utilises spatiotemporal regularisation via a maximum a posteriori framework. This constraint force allows more flexibility than the rigid forces of shape constraint-only schemes, as well as other state of the art joint shape and appearance constraints. The combined model can hypothesise defective LV borders based on prior knowledge. The authors present comparative results to illustrate the improvement gain. A brief defect detection example is finally presented as an application of the proposed method.