63 year old man with coronary artery disease s/p PCI x 3 referred to evaluate for ischemia.MEDICATIONS: amlodipine, atorvastatin, ticagrelor, metoprolol First Pass PerfusionDuring hyperemia, there is a perfusion defect involving most of the inferior wall. The defect is predominantly associated with the below described myocardial infarction. The remainder of the myocardium is free of obvious ischemia.Viability/ Myocardial ScarThere is transmural myocardial infarction, involving most of the inferior wall. This territory 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 mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 184 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 104 g. There is abnormal septal motion. There is no evidence of underlying myocardial fibrosis (aside from above myocardial infarction), infiltration, or inflammation.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 85 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 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 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. There is a transmural myocardial infarction involving much of the inferior wall. Most of it is non-viable; however, there is a small amount of peri-infarct ischemia present.2. The remainder of the myocardium is viable and free of ischemia.3. Normal LV size with mildly reduced systolic function (LVEF 49%).4. Normal RV size and systolic function (RVEF 54%).When compared to the prior study, the myocardial infarction-related perfusion defect is more evident now and the LVEF is mildly reduced now.