77 year old male with a history of lymphoma, cardiomyopathy, hypertension, hyperlipidemia, diabetes, and chronic kidney disease. Etiology of cardiomyopathy unclear.MEDICATIONS: Alendronate, Iron, Finasteride, Folic Acid, Glipizide, Insulin, Lisinopril, Metformin, Potassium, Sitagliptin. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the apical inferior wall and a very small focal transmural myocardial infarction involving the apical anterior wall, based on late gadolinium enhancement. The remainder of the myocardial is free of myocardial infarction, fibrosis, inflammation, or infiltration. The majority of the myocardium is viable.Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 126 ml (normal range 47+/-19), the LV mass index is 68 g/m2, and the LV mass is 140 g. There is hypokinesis of the apical inferior wall. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 96 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The proximal portion of the descending thoracic aorta is mildly dilated (34mm). 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; however, the diagnostic sensitivity may be limited in individuals with reduced ejection fraction.2. There is a small non-transmural myocardial infarction involving the apical inferior wall and a very small focal transmural myocardial infarction involving the apical anterior wall. The remainder of the myocardial is free of myocardial infarction, fibrosis, inflammation, or infiltration. The majority of the myocardium is viable.3. Mild left ventricular dilation with mildly reduced systolic function (LVEF 45%). There is hypokinesis of the apical inferior wall.4. Normal RV size with mildly reduced systolic function (RVEF 49%).5. Proximal portion of the descending thoracic aorta is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.