28 year old female with a history of non-ischemic cardiomyopathy who underwent heart transplant in 2007 referred for stress cardiac MRI to rule out coronary stenosis.MEDICATIONS: ASA, prednisone, Cellcept, tacrolimus. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no evidence of prior myocardial infarction. There is, however, a tiny focus of epicardial late gadolinium enhancement noted in the apical inferior wall which suggests the presence of fibrosis, inflammation, or infiltration, such as an old episode of rejection. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 51 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant morphology. 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 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 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.3. Normal LV size and systolic function (LVEF 64%) with evidence of a tiny focus of late gadolinium enhancement in the apical inferior wall. The pattern is not consistent with prior myocardial infarction and most likely represents an old episode of rejection. 4. Normal RV size and systolic function (RVEF 60%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.