A 55 year old male with history of hypertension, smoker, family history of coronary artery disease, large B cell lymphoma after chemotherapy (including doxorubicin), superior vena cava syndrome. An echocardiography before chemotherapy showed mild left ventricular systolic dysfunction without significant change after the treatment. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: esomeprazole, melatonin, metoprolol, pyridoxine. First Pass PerfusionDuring hyperemia, a perfusion defect is demonstrated by the apical and mid septum. 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 with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 60 ml/m2 (normal range: 74+/-15), the LVEDV is 133 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 25 g/m2, and the LV mass is 56 g. There are no regional wall motion abnormalities present. . No thrombus is present.No iron overload was seen.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 55%, the RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 68 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 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 pericardial effusion.
1. Perfusion defect/ "ischemia" is present during hyperemia within the mid to apical septum.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 62%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.