A 60 year old male with history of coronary artery disease, CABG in 2012 (LIMA to LAD, SVG to RPDA, SVG to OM1/OM2/LPDA). On 8/2015 he was diagnosed with non-ST elevation myocardial infarction, a left catheterization was performed and 2 stents were implanted (at anastomosis of LIMA to LAD and on native LAD). Now he is hospitalized because of chest pain with no evidence of infarction. Referred to stress CMR for further evaluation.MEDICATIONS: aspirin, bisoprolol, eplerenone, insulin, ticagrelor, lisinopril, rosuvastatin. First Pass PerfusionDuring hyperemia, a perfusion defects was noted in the base-mid and apical segments of the inferior and infero-septum walls. Viability/ Myocardial ScarThere is late gadolinium enhancement in the anterior wall at the base and mid segments and in the infero-lateral wall at the mid segment only. Both enhancements are less than 50% of the wall thickness and thus considered to be non-transmural myocardial infarctions. The rest the myocardium is viable.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 221 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 55 g/m2, and the LV mass is 133 g. There is hypokinesis of the mid and apical segments of the inferior wall . Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 233 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 111 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has three leaflets, opens widely and there is acceleration of the flow compatible with mild-moderate aortic stenosis.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 FindingsThere is azygous lobe. 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. A perfusion defects was noted in the base-mid and apical segments of the inferior and infero-septum walls. 2. There is late gadolinium enhancement in the anterior wall at the base and mid segments and in the infero-lateral wall at the mid segment only. Both enhancements are less than 50% of the wall thickness and thus considered to be non-transmural myocardial infarctions. The rest the myocardium is viable.3. Normal LV size and systolic function (LVEF 47%).4. Normal RV size and systolic function (RVEF 52%).5. Mild to moderate aortic stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.