78 year old male with history of coronary artery disease and myocardial infarction presenting with chest pain and negative biomarkers. MEDICATIONS: aspirin, plavix, metoprolol, rosuvastatin, ranolazine First Pass PerfusionDuring hyperemia, no perfusion defects were present. Dark rim artifact is noted. Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral wall. The late gadolinium enhancement spares the endocardium and is not consistent with infarction but suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 104 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 60 g. There is a sigmoid septum present. There is tardokinesis of the basal inferior and inferolateral walls. 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 55%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 111 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trivial 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 mild 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. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral wall. The late gadolinium enhancement spares the endocardium and is not consistent with prior myocardial infarction but suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 3. Normal LV size and systolic function (LVEF 58%) with tardokinesis of basal inferior and inferolateral walls.4. 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.