68 year old male with history of IPF and known coronary disease (CTO RCA, intermediate LAD disease), hypertension, AAA s/p repair and dyslipidemia presenting for evaluation of coronary disease prior to PCIMEDICATIONS: atorvastatin, amlodipine, warfarin. First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the (1) basal anteroseptum, inferoseptum, inferior, and inferolateral wall and the (2) mid inferior wall. Viability/ Myocardial ScarThere is a large myocardial infarction in the RCA territory. It is nontransmural at the basal inferoseptum, inferior, and inferolateral walls. These segments have an intermediate probability of viability. The infarction is transmural in the mid inferior wall. This segment is not viable. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with normal ventricular function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 38 g/m2, and the LV mass is 81 g. The mid to basal inferior wall is hypokinetic. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 143 ml/m2 (normal range 82+/-16), the RVEDV is 304 ml (normal range 142+/-31), the RV end systolic volume index is 107 ml/m2 (normal range 31+/-9), and the RVESV is 227 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (34 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is bilateral lung markings consistent with chronic lung disease (refer to dedicated lung imaging). Mediastinal lymph nodes are noted. 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. There is a large myocardial infarction in the territory of the right coronary artery associated with mild, peri-infarct ischemia. 2. Most of the segments affected by the infarction have an intermediate probability of viability.3. Normal LV size and systolic function (LVEF 57%) with hypokinesis of the basal to mid inferior wall.4. Moderately dilated right ventricle with severely reduced systolic function (RVEF 25%).5. Moderately dilated pulmonary artery. 6. Severe right atrial dilation. 