An 83 year old female with hypertension, paroxysmal atrial fibrillation, fatigue. A recent dobutamine echocardiography stress showed regional wall motion abnormality of the antero-septum. Referred to Stress cardiac MRI for further evaluationMEDICATIONS: Aspirin, Atenolol, Citalopram, Hydrochlorothiazide, Fluticasonem Raloxifene First Pass PerfusionDuring hyperemia, there is a transmural perfusion defect involving the basal inferior, inferolateral, and anterolateral walls. The overall ischemia score is 6 out of a total 32 and 14% of the ventricle is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. There is nearly circumferential hypertrophy of the basal left ventricle of unclear significance with a maximum wall thickness of 13mm; the remainder of the ventricle has normal wall thickness (~6mm). The overall LV ejection fraction is 65%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 119 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 58 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 184 ml (normal range 110+/-24), the RV end systolic volume index is 57 ml/m2 (normal range 22+/-8), and the RVESV is 88 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. 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. There is mild mitral valve prolapse.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe 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 FindingsSmall right lower lung infiltrate of unclear significance, correlation with chest x-ray or chest CT suggested. 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. There is a moderate amount of "ischemia" involving the basal inferior, inferolateral, and anterolateral walls. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%). There is nearly circumferential hypertrophy limited to the basal left ventricle which is of unclear significance. There is no underlying myocardial fibrosis, inflammation, or infiltration. 4. Moderate RV dilation with mildly reduced systolic function (RVEF 48%).5. There is mild mitral valve prolapse.6. Significant biatrial dilation.7. Moderate to severe tricuspid regurgitation.8. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.