55 year-old woman with sickle cell disease, mild pulmonary hypertension with exercise associated hypoxia, diastolic dysfunction and renal disease. Resting echocardiogram suggested mildly reduced LVEF and wall motion abnormalities. Stress MRI ordered to rule out ischemia and to assess for iron overload MEDICATIONS: ASA and Furosemide First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 moderate-severely dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 119 ml/m2 (normal range: 65+/-11), the LVEDV is 200 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 93 ml (normal range 31+/-10), the LV mass index is 86 g/m2, and the LV mass is 144 g. There tardokinesis of the basal inferior and inferolateral walls. T2* (myocardium) = 43ms. T2* (liver) = 4.6 ms.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 183 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 69 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly 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.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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.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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is evidence of iron overload in the liver. Interstitial changes noted in both lungs. There is axillary adenopathy. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate-severely dilated LV with low normal systolic function (LVEF 53%). There tardokinesis of the basal inferior and inferolateral walls. 4. T2* (myocardium) = 43ms. T2* (liver) = 4.6 ms. This is consistent with iron overload of the liver but no evidence of myocardial iron overload.5. Mildly dilated RV with normal systolic function (RVEF 62%).6. Moderately dilated left atrium. Mildly dilated right atrium.