53 year old female with sjogren's, diabetes, hypertension and known coronary artery disease with history of chronic total occlusion of right coronary artery (s/p PCI 12/2015) presenting for evaluation post interventionMEDICATIONS: aspirin, atorvastatin, bumetanide, carvedilol, lisinopril, clopidogrel, ranolazine, spironolactone First Pass PerfusionDuring hyperemia, there is a perfusion defect ("ischemia") in the RCA territory, specifically there are perfusion defects in mid to basal inferior and inferolateral walls. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 185 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 29 g/m2, and the LV mass is 60 g. There is basal to mid inferior and possibly inferolateral hypokinesis. Native T1 time approximately 1110 ms (LV cavity 1550 ms). There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. 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 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. During hyperemia, there is a perfusion defect ("ischemia") in the RCA territory, specifically there are perfusion defects in the mid to basal inferior and inferolateral walls. 2. There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. 3. Normal LV size and systolic function (LVEF 60%).4. Normal RV size and systolic function (RVEF 64%).