This study investigates the performance of different stationary and semi-stationary multi-pinhole (MPH) designs with a dual-head L-mode configuration as compared to that of a conventional low-energy high-resolution (LEHR) collimator for myocardial perfusion (MP) single-photon emission computed tomography (SPECT). The target field of view for the heart was 16 cm with a target resolution of 1 cm. The design parameters were determined by maximizing the detection efficiency based on the system constraints. Three stationary designs (L-modes I to III) and semi-stationary designs (S-modes I to III) with four detector positions (i.e., 2 L-mode positions at various angles apart) were evaluated. We used the XCAT phantom with 99mTc-sestamibi distribution and a three-dimensional analytical MPH/LEHR projector to generate noise-free and noisy projections, which were reconstructed using the maximum-likelihood expectation-maximization algorithm with up to 180 updates. A two-dimensional (2D) region of interest with 32 × 32 pixels covering the central axial slice of the left ventricle was analyzed using normalized mean-squared error (NMSE), normalized standard deviation (NSD), and a 2D bias map. The optimized design parameters are 12 pinholes, an acceptance angle of 51°, an aperture size of 4.6