64 year old female with CAD s/p CABG in 1999, PAD s/p aortobifemoral bypass, with recent admission for angina. MEDICATIONS: Amlodipine, ASA, Atorvastatin, Plavix, HCTZ, Lisinopril, Metoprolol XL, Spironolactone Viability/ Myocardial ScarBased on late gadolinium enhancement imaging, there was a non-transmural myocardial infarction involving the basal inferior and inferolateral walls, the mid inferior and inferolateral walls, and the apical inferior wall. Based on late gadolinium enhancement imaging, these segments would be classified as having an intermediate probability of viability; however, following the administration of intermediate dose dobutamine, there was no improvement in contractility in these infarcted segments which would reclassify these segments as being unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 128 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 91 ml/m2 (normal range 18+/-5), the LVESV is 157 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 112 g. There is hypokinesis of the basal and mid inferolateral and inferior walls. The basal anteroseptum is also hypokinetic. Left AtriumThe left atrium is moderate to severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 59 ml/m2 (normal range 69+/-14), the RVEDV is 106 ml (normal range 110+/-24), the RV end systolic volume index is 26 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 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 no obvious pericardial disease.Extracardiac FindingsSternal wires are 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. Based on late gadolinium enhancement imaging, there was a non-transmural myocardial infarction involving the basal inferior and inferolateral walls, the mid inferior and inferolateral walls, and the apical inferior wall. Based on late gadolinium enhancement imaging, these segments (i.e. usual territory of the left circumflex artery) would be classified as having an intermediate probability of viability; however, following the administration of intermediate dose dobutamine, there was no improvement in contractility in these infarcted segments which would reclassify these segments as being unlikely to be viable. The remainder of the myocardium (LAD and RCA territory) is free of myocardial infarction and likely to be viable. 2. Severely dilated and severely reduced LV systolic function (LVEF 29%). There is a regional wall motion abnormality as described above. 3. Normal RV size and systolic function (RVEF 56%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.