62 year old man with systolic heart failure and worsening fatigue who presents for Cardiac MRI to evaluate for possible ischemic etiologyMEDICATIONS: Norvasc, Aspirin, Lipitor, Lasix, Lisinopril, Toprol XL First Pass PerfusionDuring hyperemia, there are reversible perfusion defects noted in the entire apex and mid anterior, anteroseptal, and inferoseptal segments. The overall ischemia score is 7 out of 32 and 22% of the myocardium is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and mildly reduced in systolic function. The overall LV ejection fraction is 43 %, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 204 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 116 ml (normal range 47+/-19), the LV mass index is 53 g/m2, and the LV mass is 119 g. There is global hypokinesis. 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 53%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17).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 is a mild but large burden of ischemia in the usual territory of the left anterior descending artery. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with mildly reduced systolic function (LVEF 43%). No underlying myocardial fibrosis, inflammation, or infiltration is noted.4. Normal RV size and systolic function (RVEF 53%).