63 year old with history of diabetes, coronary disease s/p LAD PCI, and HTN presenting for evaluation of coronary artery diseaseMEDICATIONS: amlodipine, aspirin, atorvastatin, valsartan, HCTZ, metoprolol First Pass PerfusionDuring hyperemia, there are perfusion defects in the mid to basal infero-septal, inferior, inferolateral walls and a defect in the apical lateral wall. This corresponds to ischemia of approximately 44% of the myocardium. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 46 g/m2, and the LV mass is 85 g. There is mid to basal inferior and inferolateral hypokinesis. There is small area of late gadolinium enhancement noted in the proximal apical septum (non-transmural, less than 50%) in a pattern consistent with myocardial infarction. Additionally, there is an small area in the mid infererolateral wall with nontransmural (<50%) LGE which likely consistent with myocardial infarction and is intermediate probability of being viable. The remaining myocardium is viable. Left AtriumThe left atrium is mildly dilated. 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 80 ml/m2 (normal range 69+/-14), the RVEDV is 149 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 54 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. There are perfusion defects in the mid to basal infero-septal, inferior, inferolateral walls and a defect in the apical lateral wall. This corresponds to ischemia of approximately 44% of the myocardium. 2. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%.There is mid to basal inferior and inferolateral hypokinesis. There is small area of late gadolinium enhancement noted in the proximal apical septum (non-transmural, less than 50%) in a pattern consistent with myocardial infarction. Additionally, there is an small area in the mid infererolateral wall with nontransmural (<50%) LGE which likely consistent with myocardial infarction and is intermediate probability of being viable. The remaining myocardium is viable. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.