64 year old man with new bi-ventricular heart failure, referred for further evaluation of inducible ischemia and viability.MEDICATIONS: Aspirin, Lipitor, Lasix, Lisinopril, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was a small area of late gadolinium enhancement at the RV insertion point. Otherwise there 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. LV mass is mildly increased. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 160 ml/m2 (normal range: 74+/-15), the LVEDV is 264 ml (normal range 142+/-34), the LV end systolic volume index is 129 ml/m2 (normal range 25+/-9), the LVESV is 213 ml (normal range 47+/-19), the LV mass index is 123 g/m2, and the LV mass is 209 g. LV dysfunction is global with regional variation. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. On LGE imaging, there is a thrombus noted in the right atrial appendage. Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve has bi-leaflet tethering. There is mild 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 (24mm).Venous AnatomyThe SVC and IVC 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. Small area of late gadolinium enhancement noted at the RV insertion point.3. Severely dilated LV with severely reduced LV ejection fraction (LVEF 19%). There is global hypokinesis with regional variation.4. Normal RV size with severely reduced systolic function (RVEF 26%).5. Thrombus in the right atrial appendage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.