80 year old man with palpitations, NSVT, dyspnea referred for evaluation of underlying ischemia.MEDICATIONS: ASA, lisinopril, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is an area of late gadolinium enhancement noted in the basal inferolateral wall which spares the endocardium. It is in a pattern atypical for infarction and may suggest a fibrotic, inflammatory, or infiltrative process. The entire myocardium is otherwise viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 65 ml (normal range 47+/-19), the LV mass index is 42 g/m2, and the LV mass is 89 g. There are no regional wall motion abnormalities present. 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 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. No evidence of aortic valve mass.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%. There is an area of late gadolinium enhancement noted in the basal inferolateral wall in a pattern that is atypical for infarction and may suggest the presence of a localized fibrotic, inflammatory, or infiltrative process. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%.5. Moderate tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.