72 year old man with mildly reduced LV systolic function referred to rule out ischemic heart disease. His history is significant for lymphoma which is treated with chemotherapy.  MEDICATIONS: ASA, lisinopril, and simvastatin. First Pass PerfusionDuring hyperemia, no perfusion defects were present.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. Of note, the native myocardial T1 relaxation time was moderately elevated in the basal inferior and inferolateral walls suggesting the presence of either subtle interstitial fibrosis or myocardial edema. Left VentricleThe left ventricle is normal size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 175 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 79 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 71%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 a trivial pericardial effusion.Extracardiac FindingsLarge right sided pleural effusion with adjacent atelectasis or consolidation is noted. Mediastinal lymphadenopathy is noted. 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.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function (LVEF 54%). There is no late gadolinium enhancement; however, the native myocardial T1 relaxation time was moderately elevated in the basal inferior and inferolateral walls suggesting the presence of either subtle interstitial fibrosis or myocardial edema. 4. Normal RV size and systolic function (RVEF 71%).5. See extra-cardiac findings. 