74 year old woman with stable chest pain but progressive shortness of breath. She has a history of known coronary artery disease. First Pass PerfusionDuring hyperemia, the patient has perfusion defects involving the basal anterior, anterolateral, and inferolateral walls, the mid inferoseptal, inferior, and inferolateral wall, and the apical anterior, lateral, inferior, and septal walls which were not present on the resting images. The overall ischemia score is 10 out of a possible 30 and the burden of myocardial ischemia is approximately 33%.Viability/ Myocardial ScarThere is a small transmural myocardial infarction involving the mid inferior wall. This segment is not viable; however, the remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left VentricleThe left ventricle is normal in size with low normal systolic function. There is hypokinesis of the mid inferior wall. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 116 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 58 ml (normal range 31+/-10), the LV mass index is 61 g/m2, and the LV mass is 97 g. Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is normal in size and systolic function. The RV ejection fraction is 62%, the RV end diastolic volume index is 50 ml/m2 (normal range 69+/-14), the RVEDV is 80 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 50 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 no significant 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 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 a trivial pericardial effusion.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. Approximately a third of the myocardium is ischemic. The ischemia is distributed in a multivessel pattern (LAD, LCx, and RCA) as described above.2. There is a small transmural myocardial infarction involving the mid inferior wall. This segment is unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is viable.3. Normal LV size with low normal systolic function (LVEF 50%). There is hypokinesis of the basal inferior wall. 4. Normal RV size and systolic function (RVEF 62%).Findings were conveyed to referring physician. 