73 year old with hypertension and dyslipidemia now with acute myeloid leukemia found to have left ventricular systolic dysfunction and a possible LV apical thrombus. MEDICATIONS: metoprolol and lasix First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere was no evidence of myocardial infarction. There is a small amount of an atypical pattern of late gadolinium enhancement involving the epicardial half of the basal inferior wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. This segment has an indeterminate probability of viability. The remainder of the myocardium is likely to be viable. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 217 ml (normal range 109+/-23), the LV end systolic volume index is 70 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 69 g/m2, and the LV mass is 136 g. The left ventricular systolic dysfunction is global with regional variation. The apical "mass" noted on echo most likely represents a small muscular band rather than a thrombus or tumor.Left AtriumThe left atrium is moderate to severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 260 ml (normal range 110+/-24), the RV end systolic volume index is 96 ml/m2 (normal range 22+/-8), and the RVESV is 189 ml (normal range 35+/-13). Right AtriumThe right atrium is moderate to severely dilated. 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 to moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a variant brachiocephalic branching pattern. There is an aberrant brachiocephalic vessel (either the innominate artery or just the right subclavian artery) originating from the proximal portion of the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate bilateral pleural effusions and right lower lung consolidation. 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. There was no evidence of myocardial infarction. There is a small amount of an atypical pattern of late gadolinium enhancement involving the epicardial half of the basal inferior wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. This segment has an indeterminate probability of viability. The remainder of the myocardium is likely to be viable. 3. Severe LV dilation with moderately reduced systolic function (LVEF 36%). No evidence of LV apical mass or thrombus. The finding noted on echo most likely represents a small muscular band.4. Severe RV dilation with severely reduced systolic function (RVEF 28%).5. Mild mitral and tricuspid regurgitation.6. Mild dilation of the main pulmonary artery. 7. Variant brachiocephalic arch branching pattern.8. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.