48 year old female with a history of diastolic dysfunction, secondary pulmonary hypertension, hypertension, hyperlipidemia, gastric bypass surgery, and family history of ischemic cardiomyopathy in father. She is referred for stress cardiac MRI. MEDICATIONS: Aspirin, Furosemide, Insulin, Metolazone, Rosuvastatin, Sildenafil, Spironolactone First Pass PerfusionDuring hyperemia, no perfusion defects were present.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 with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 52 ml (normal range 31+/-10), the LV mass index is 21 g/m2, and the LV mass is 39 g. There are no regional wall motion abnormalities present. No evidence of myocardial iron overload. The pre-contrast native myocardial T1 relaxation times are normal (1044 ms). 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 58%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 125 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. 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 trace 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 FindingsThere is evidence of hepatic iron overload. This 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. Normal LV size and systolic function (LVEF 58%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size and systolic function (RVEF 58%).5. Evidence of hepatic iron overload. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.