54 year old man with NASH cirrhosis, hypertension, diabetes and known coronary disease (50% LAD lesion on 2014 coronary angiography) who presents for vasodilator stress testing to evaluate for ischemia as part of a pre-transplant evaluation.MEDICATIONS: lasix, nadolol, insulin, spironolactone, omega 3 fatty acid First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 146 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately 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 78 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 62 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumTrivial pericardial fluid is present.Extracardiac FindingsNodular appearance to liver consistent with cirrhosis with exuberant gastroesophageal varices. Left renal cyst. This 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. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 64%).5. Mild main PA dilation.6. Nodular appearance to liver consistent with cirrhosis with exuberant gastroesophageal varices.