65yr old male with history of DLBCL evolved from CLL s/p SCT and heart failure presenting for cardiac evaluation. MEDICATIONS: lisinopril, furosemide, carvedilol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarNo evidence of myocardial infarction. There is no definitive late gadolinium enhancement noted to suggest that there is replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which suggest the presence of diffuse interstitial myocardial fibrosis or edema. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 213 ml (normal range 142+/-34), the LV end systolic volume index is 67 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 148 g. The LV dysfunction is global. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 89 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant 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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a partially loculated pericardial effusion which is moderate in size along the mid to apical RV free wall. There is a much smaller circumferential pericardial effusion. Extracardiac FindingsThis 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.2. No evidence of myocardial infarction. There is no late gadolinium enhancement noted to suggest the presence of replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which would suggest the presence of diffuse interstitial fibrosis or edema. 3. Moderately dilated LV size and mildly reduced systolic function (LVEF 48%).4. Normal RV size and systolic function (RVEF 52%).