A 62 year old female with history of coronary artery disease, s/p non-ST elevation myocardial infarction (2009) and coronary arterial bypass graft (SVG to OM 1/2/3 and LIMA to LAD), ischemic cardiomyopathy with a left ventricular systolic function of 42% (by cardiac MRI of 4/30/2015), hypertension, COPD, diabetes, mild chronic kidney disease, peripheral arterial disease, Hodgkin's lymphoma s/p chemotherapy. Referred to stress cardiac MRI for further evaluation. MEDICATIONS: amiodarone, aspirin, atorvastatin, furosemide, gabapentin, insulin, metoprolol, ranolazine, sitagliptin, spiriva, spironolactone. First Pass PerfusionDuring hyperemia, there is an extensive, severe perfusion defect that involves the entire left ventricle, except the basal to mid lateral wall. Viability/ Myocardial ScarThere are two myocardial infarctions each of which have both transmural and non-transmural components to them. They involve the (1) mid anterolateral, inferolateral, and inferior walls and (2) apical anterior, lateral, inferior, and septal walls. The segments affected by these myocardial infarctions have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 65 ml/m2 (normal range 18+/-5), the LVESV is 116 ml (normal range 31+/-10), the LV mass index is 70 g/m2, and the LV mass is 124 g. There is global hypokinesis with regional variation. No intracavitary thrombus was noted.Left AtriumThe left atrium is mildly dilated (106 ml). 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 63 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 51 ml (normal range 35+/-13). 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 trivial 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 "pseudo-bovine" pattern (normal variant). 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 FindingsSternal wires were noted. Previously noted hepatic angioma or cyst is seen again.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. Extensive, severe myocardial ischemia associated with significant amount of myocardial viability. 2. Two large myocardial infarctions, as described above, are noted. 3. The left ventricle is mildly dilated with moderately reduced systolic function (LVEF 32%). 4. Normal RV size and systolic function (RVEF 55%).5. Mild LA dilation.When compared to the prior study from 4/30/2015, the LVEF has worsened. Stress testing was not performed on the prior study. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.