63 year old male with a history of heart failure with reduced ejection fraction, hyperlipidemia referred for stress cardiac MRI.MEDICATIONS: Atorvastatin, Benazepril, Carvedilol, and Eplerenone First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is evidence of mid-myocardial late gadolinium enhancement noted in the mid to basal septum and inferoseptum. This is atypical for myocardial infarction and may suggest prior myocarditis or fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is mildly dilated with moderately-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 239 ml (normal range 142+/-34), the LV end systolic volume index is 77 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 29 g/m2, and the LV mass is 57 g. There is global hypokinesis. The pre-contrast native myocardial T1 relaxation time was normal (1030 ms). Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 194 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 105 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild 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 40 mm. 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 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. No perfusion defects/ "ischemia" present during hyperemia. 2. The left ventricle is mildly dilated with moderately-severely reduced systolic function (LVEF 34%). There is global hypokinesis.3. The right ventricle is normal in size with mildly reduced systolic function (RVEF 46%).4. There is mid-myocardial late gadolinium enhancement noted in the mid to basal septum and inferoseptum. This is atypical for myocardial infarction and may suggest prior myocarditis or fibrosis, inflammation, or infiltration. 5. Mild biatrial dilatationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.