72 year old woman who presents with congestive heart failure and multiple risk factors. She is referred to rule out ischemia and to evaluate etiology of LV dysfunction.MEDICATIONS: carvedilol, furosemide, aspirin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere was no evidence of myocardial infarction. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal septum and an epicardial late gadolinium enhancement pattern involving the basal inferolateral wall. These findings are atypical for prior myocardial infarction and suggest underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 235 ml (normal range 109+/-23), the LV end systolic volume index is 87 ml/m2 (normal range 18+/-5), the LVESV is 167 ml (normal range 31+/-10), the LV mass index is 83 g/m2, and the LV mass is 159 g. There is global hypokinesis with regional variation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 128 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. Mild atherosclerosis is noted in the descending thoracic aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral axillary lymph nodes noted. The largest on the right is 1cm and on the left is 1.2cm. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.
1. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of vasodilator stress testing in the presence of severe LV dysfunction is reduced.2. There was no evidence of myocardial infarction. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal septum and an epicardial late gadolinium enhancement pattern involving the basal inferolateral wall. These findings are atypical for prior myocardial infarction and suggest underlying myocardial fibrosis, inflammation, or infiltration suggesting a non-ischemic etiology of the cardiomyopathy. 3. Severe LV dilation with severely reduced systolic function (LVEF 29%).4. Normal RV size and systolic function (RVEF 55%).5. Severe left atrial dilation.6. Moderate mitral regurgitation.7. Axillary lymph nodes are noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.