83 year old with coronary artery disease s/p TECAB (LIMA to LAD) and RCA stents in 2008. He presents with recurrent angina. MEDICATIONS: aspirin, Omega-3, atorvastatin, fenofibrate, lisinopril, metoprolol, niacin, and NTG First Pass PerfusionDuring hyperemia, 2 distinct perfusion defects were noted. The first is mild to moderate in severity and involves the basal inferior inferolateral walls, the mid inferolateral wall, and the apical inferior wall. The second is severe and involves the mid anteroseptum. The overall ischemic burden of the left ventricle is 18%.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 overall systolic function. There is tardokinesis of the basal inferior wall. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 47 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 129 g. Left AtriumThe left atrium is mildly dilated. There is lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 124 ml (normal range 142+/-31), the RV end systolic volume index is 20 ml/m2 (normal range 31+/-9), and the RVESV is 40 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is mildly calcified and has mild aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is mild 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 2 distinct regions of ischemia as described above. Approximately 18% of the myocardium is ischemic. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 61%). There is tardokinesis of the basal inferior wall.4. Normal RV size and systolic function (RVEF 68%).5. Mild aortic valve calcification with mild aortic regurgitation. 6. Lipomatous hypertrophy of the interatrial septum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.