72 year old diabetic male patient with stable coronary artery disease and distal RCA CTO, HTN, HLD, worsening symptoms on medical therapy, referred for cardiac stress MRI to assess perfusion and scar.MEDICATIONS: Advair, Proair, alfuzosin, ASA, dutasteride, glipizide, Imdur, losartan, metoprolol (held), nitroglycerine, omeprazole, pravastatin, tizanidine, dyazide. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is no late gadolinium enhancement suggestive of prior myocardial infarction. The entire myocardium is viable. Minimal mid myocardial late gadolinium enhancement in the basal septum seen only on 4 chamber view, possibly artifact.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 157 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 53 g/m2, and the LV mass is 115 g. There are no regional wall motion abnormalities present. 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 51%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 190 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).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 mildly dilated (39mm at the sinuses of valsalva). There is a left sided bovine aortic arch.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (35mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLeft posterior diaphragmatic hernia 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. Minimal mid myocardial late gadolinium enhancement in the basal septum seen only on 4 chamber view, possibly artifact.3. Normal LV size and systolic function (LVEF 55%).4. Normal RV size and systolic function (RVEF 51%).