A 27 year old male with an antero-lateral ST elevation myocardial infarction on 1/2015 with PCI to proximal left anterior descendent artery, an echocardiography showed left ventricular ejection fraction of 35% (3/2015). Referred to stress cardiac MRI because of chest pain.MEDICATIONS: aspirin, atorvastatin, metoprolol, niacin, ramipril, ticagrelor. First Pass PerfusionDuring hyperemia, perfusion defects were present in the (1) basal anteroseptum, anterolateral, and inferolateral walls; (2) mid anteroseptum, anterior, and anterolateral walls; and (3) apical septum. The overall ischemia score is 5 and 19% of the myocardium is ischemic. Viability/ Myocardial ScarThere is a large transmural myocardial infarction involving the mid to apical anterior wall and the mid anterolateral wall. The remainder of the myocardium is free of myocardial infarction and is viable.Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 225 ml (normal range 142+/-34), the LV end systolic volume index is 68 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 44 g/m2, and the LV mass is 85 g. There is hypokinesis of the mid to apical anterior wall and the mid anterolateral wall. There is no intracavitary thrombus is noted.Left AtriumThe left atrium is normal in size (89ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVEDV is 190 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 85 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.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 is a large transmural myocardial infarction in the LAD territory which has a mild to moderate amount of residual peri-infarct ischemia.2. There is a small amount of mild ischemia in the usual territory of the left circumflex artery. This territory, however, was difficult to interpret due to the presence of a nearby imaging artifact. 3. The territories affected by the myocardial infarction described in the body of the report above are not viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. 4. The left ventricle is mildly dilated with mildly reduced systolic function (LVEF 42%). There is hypokinesis and thinning of mid to apical anterior wall and the mid anterolateral wall. 5. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.