74 year old man with pAF, HTN, new inferior hypokinesis on echo, referred for ischemia evaluation. MEDICATIONS: Pindolol, Xarelto, Zetia First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is mid-wall/ epicardial myocardial late gadolinium enhancement noted in the basal inferolateral wall. The pattern is atypical for myocardial infarction and may suggest underlying fibrosis, inflammation, or infiltration. It was present on CMR in 2010 and is unchanged. The remainder of the myocardium is viable without evidence of any myocardial infarction.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 108 ml (normal range 47+/-19), the LV mass index is 53 g/m2, and the LV mass is 121 g. There is no regional wall motion abnormality. The basal inferior and inferolateral walls show evidence of a "pseudo-wall motion abnormality," which is in fact, through plane of motion of the mitral anular plane and the left atrium and not a true wall motion abnormality. Sigmoid septum is noted. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVEDV is 227 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 83 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 mild to moderate mitral regurgitation. There is bileaflet mitral valve prolapse. 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 upper limits of normal.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 normal in size with normal systolic function without evidence of regional wall motion abnormality. The overall LV ejection fraction is 53%. There is epicardial/ mid myocardial late gadolinium enhancement noted in the basal inferior/inferolateral wall. The pattern is atypical for myocardial infarction and may suggest underlying fibrosis, inflammation, or infiltration. It was present on CMR in 2010 and is unchanged. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%4. Mitral valve prolapse with mild to moderate mitral regurgitation noted. When compared to the prior cardiac MRI from 2010, the LVEF is slightly lower. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.