80 year old male with hypertension, hyperlipidemia, coronary artery disease, diabetes, peripheral arterial disease, and hyperthyroidism. Prior anterior MI in 1996 treated medically. PCI of RCA and LCx in 2012. Cath in January 2015 showed ostial occlusion of RCA stent with collateralization, and 75% stenosis of LAD. DES placed in LAD.MEDICATIONS: ASA, atorvastatin, carvedilol, plavix, digoxin, fluticasone, gabapentin, levothyroxine, mefoxin, clarithromycin, moxifloxacin. First Pass PerfusionDuring hyperemia a perfusion defect was noted in (1) the basal to mid inferior and inferoseptal walls and (2) basal to mid anterolateral and inferolateral walls. Viability/ Myocardial ScarThere is a large transmural myocardial infarction involving much of the LAD territory, which is unlikely to be viable. There is no evidence of myocardial infarction in most of the LCx and RCA territories, which are likely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is marked thinning and akinesis in most of the LAD territory. There is hypokinesis in the RCA territory. There is normal wall motion in the LCx territory. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 180 ml/m2 (normal range: 74+/-15), the LVEDV is 277 ml (normal range 142+/-34), the LV end systolic volume index is 145 ml/m2 (normal range 25+/-9), the LVESV is 222 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 110 g. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 81 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 31 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mild diastolic mitral regurgitation suggesting increased left ventricular end-diastolic pressure. 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. There is a transmural myocardial infarction in the LAD territory.2. There is mild ischemia with normal wall motion and viability in the LCx territory.3. There is severe ischemia with hibernating myocardium and viability in the RCA territory. 4. Severe left ventricular dilation with severely reduced systolic function (LVEF 20%).5. Normal RV size and systolic function (RVEF 61%).6. Mild aortic regurgitation.7. There is mild diastolic mitral regurgitation suggesting high left ventricular end-diastolic pressure. 