A 83 year old male with history hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease and prostate cancer. He has history of coronary artery disease including bypass surgery in 2001 (LIMA to LAD, SCG to OM and LP) and multiple subsequent PCI's. A recent echocardiography showed normal function of the left and right ventricles. Recently was hospitalized due to progressive dyspnea and chest pain. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: aspirin, atorvastatin, budesonide, clopidogrel, insulin, lisinopril, tamsulosin. First Pass PerfusionDuring hyperemia, a perfusion defect was present at the lateral (transmural) and inferolateral (subendocardial) at the base and mid segments. The burden of the ischemia is 5/32 potential segments (16%).Viability/ Myocardial ScarThere is late gadolinium enhancement noted in the base to mid segments of the lateral and inferior walls in up to 50% of the thickness of the myocardium. This finding is compatible with prior myocardial infarction. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 101 g. There are no regional wall motion abnormalities present. Normal myocardial T1-times.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 49 ml/m2 (normal range 82+/-16), the RVEDV is 105 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is at least mild-to moderate 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 pericardial effusion.Extracardiac FindingsSternal wires were seen. 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. During hyperemia, a perfusion defect was present at the lateral (transmural) and inferolateral (subendocardial) at the base and mid segments. The burden of the ischemia is 5/32 potential segments (16%).2. There is late gadolinium enhancement noted in the base to mid segments of the lateral and inferior walls in up to 50% of the thickness of the myocardium. This finding is compatible with prior myocardial infarction. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 53%).