55 year old man with paroxysmal atrial fibrillation, non ischemic cardiomyopathy, referred for further evaluation of inducible ischemia and pre atrial fibrillation ablation planning.MEDICATIONS: Lisinopril, Toprol XL, Xarelto, Multaq First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no obvious late gadolinium enhancement to suggest an underlying myocardial fibrosing, infiltrative, or inflammatory process. No evidence of prior myocardial infarction. The myocardial is viable. Left VentricleThe left ventricle is normal in size (when adjusted for body surface area) with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 32 g/m2, and the LV mass is 85 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is 131ml (moderately dilated). No obvious left atrial appendage thrombus. Normal pulmonary venous anatomy.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 34%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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 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. No perfusion defects/ "ischemia" present during hyperemia.2. No evidence of myocardial infarction or other forms of myocardial fibrosis, inflammation, or infiltration. The myocardium is viable. 3. Normal LV size (when adjusted for body surface area) and moderately reduced systolic function (LVEF 34%).4. Normal RV size and moderately reduced systolic function (RVEF 34%).5. Moderate biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.