34 year old woman with history of NICM, SLE, referred for evaluation of underlying ischemia and fibrosis.MEDICATIONS: Coreg, lisinopril, warfarin 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 severely dilated with moderate to severely reduced systolic function. There is severe thinning and akinesis of the basal to mid anterolateral and inferolateral walls. The basal inferior wall is hypokinetic. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 120 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 84 ml/m2 (normal range 18+/-5), the LVESV is 155 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 119 g. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 82 ml/m2 (normal range 22+/-8), and the RVESV is 149 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. There is tethering of the posterior leaflet with moderate to severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 FindingsBilateral lower lung consolidation versus infiltrates. 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; however, the diagnostic sensitivity of vasodilator stress testing is reduced in patients with significant LV dysfunction. Additionally, given the below regional wall motion abnormality, I would be concerned that the ischemic burden is being underestimated.2. No prior myocardial infarction. The entire myocardium is viable.3. Severe LV dilation with moderate to severe systolic dysfunction (LVEF 30%). There is severe thinning and dyskinesis of the basal to mid inferolateral and anterolateral walls suggesting the presence of hibernating myocardium. 4. Mild RV dilation with severely reduced systolic function (RVEF 23%).5. Tethering of the posterior mitral leaflet associated with at least moderate to severe ischemic mitral regurgitation.6. Moderate tricuspid regurgitation.7. Severe left atrial dilation.8. Bilateral lower lung consolidation versus infiltrate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.