55 year ol woman with history of heart failure with preserved LVEF, referred for vasodilator stress testing as part of research trial.MEDICATIONS: amlodipine, ASA, lipitor, coreg, enalapril, lasix, aldactone. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a borderline region of late gadolinium enhancement involving the basal inferior and inferolateral wall. The pattern is atypical for prior myocardial infarction and 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 67%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10), the LV mass index is 80 g/m2, and the LV mass is 140 g. There is moderate concentric left ventricular hypertrophy (IVS 13mm). There are no regional wall motion abnormalities present. The native myocardial T1 time is 1205ms, which is significantly elevated. The extracellular volume fraction is 36% (normal 20-30%). Both of these findings also support the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 46 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 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 "psuedo-bovine" brachiocephalic branching pattern (normal variant). Mild atherosclerosis is noted in the descending aorta. 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThyroid enlargement is noted. 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. There is a borderline region of late gadolinium enhancement involving the basal inferior and inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The native myocardial T1 time is 1205ms, which is significantly elevated. The extracellular volume fraction is 36% (normal 20-30%). Both of these findings also support the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. Normal LV size and systolic function (LVEF 67%). There is moderate concentric left ventricular hypertrophy.4. Normal RV size and systolic function (RVEF 63%).5. Mild atherosclerosis is noted in the descending aorta.6. Thyroid enlargement is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.