72 year old woman with new heart failure, referred for further ischemic evaluation.MEDICATIONS: ASA, Coreg, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 194 ml (normal range 109+/-23), the LV end systolic volume index is 88 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 85 g/m2, and the LV mass is 135 g. LV dysfunction is global with regional variation. The native myocardial T1 relaxation time is 1150ms, suggesting the presence of mild, diffuse underlying interstitial fibrosis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant 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. The thoracic aorta is severely tortuous. 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 FindingsThe hepatic T1 time is reduced suggesting that there may be hepatic iron overload present. 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 may be reduced in patients with severe LV dysfunction.2. No prior myocardial infarction. The entire myocardium is viable.3. Severely dilated with severely reduced systolic function (LVEF 28%) without evidence of late gadolinium enhancement. Increased native myocardial T1 relaxation times are noted and suggest that there may be mild diffuse interstitial fibrosis present.4. Normal RV size with mildly reduced systolic function (RVEF 48%).5. Severe left atrial dilation.6. Mild to moderate mitral regurgitation.7. Mild aortic regurgitation.8. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.