64 year old male with a history of coronary artery disease, myocardial infarction, and new onset systolic heart failure who presents today for a second opinion regarding heart failure management. First Pass PerfusionDuring hyperemia, there were perfusion defects in the basal inferior, inferolateral, and inferoseptal walls; the mid inferoseptal, inferolateral, and anteroseptal walls; and in the apical inferior and septal walls.  Viability/ Myocardial ScarThere was transmural myocardial infarction involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior and septal walls. The segments are unlikely to be viable. The remainder of the myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely systolic function. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 159 ml/m2 (normal range: 74+/-15), the LVEDV is 343 ml (normal range 142+/-34), the LV end systolic volume index is 130 ml/m2 (normal range 25+/-9), the LVESV is 281 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 116 g. There is thinning and akinesis of the LAD territory. There is hypokinesis of the remainder of the other other coronary territories. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 53 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 44 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 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 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 significant amount of ischemia and viability in the RCA and LCx territories.2.There is a very large myocardial infarction in the LAD territory which is not viable. 3.Severely dilated LV with severe systolic dysfunction (LVEF 18%). There is a large akinetic region involving much of the LAD territory.4.Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.