57 year old male with heart failure with reduced ejection fraction (HFrEF), s/p renal transplant in 2007, COPD, HTN, DM, NSTEMI during neutropenic sepsis recently, cardiac cath deferred due to acute kidney injury, atrial fibrillation. Evaluation for viability/scar. First Pass PerfusionDuring hyperemia, no perfusion defects were presentViability/ Myocardial ScarThere is no evidence of prior myocardial infarction. There is a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is mildly decreased 49%. The LVEDV is 187 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 96 ml (normal range 47+/-19) and the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9). The LV mass is 172 g (normal range 164+/-36) and the LV mass index is 90 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%. The RVEDV is 164 ml (normal range 142+/-31), RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVESV is 80 ml (normal range 54+/-17), and the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.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 FindingsThere are small bilateral pleural effusions and a possible right lung infiltrate near the hilum, correlation with recent non-contrast chest CT or chest x-ray suggested. 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. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly decreased systolic function (LVEF 49%) with a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. The pattern is not consistent with prior myocardial infarction.4. Normal RV size with normal systolic function (RVEF 51%). See extra cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.