A 76 year old male with history of hypertension, hyperlipidemia and coronary artery disease: in a recent hospitalization a left cath showed chronic total occlusion of the left circumflex and 95% of the right coronary artery, a stent was implanted to the RCA. The echocardiography showed normal left ventricular function. Now referred to stress cardiac MRI for further evaluation due to fatigue.MEDICATIONS: aspirin, ticagrelor, metoprolol, ramipril, atorvastatin, tamsulosin. First Pass PerfusionDuring hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). Viability/ Myocardial ScarThere was late gadolinium enhancement at the base and mid level of the inferolateral walls, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 129 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 112 g. There is mild hypokinesis of the basal and mid segments of the inferolateral wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 73 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. During hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). 2. There was late gadolinium enhancement at the base and mid level of the inferolateral wall, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.