A 56 year old female with congestive heart failure, hypertension, hyperlipidemia, obesity, hypothyroidism and breast cancer. Pre-treatment of Herceptin, an echocardiography showed left ventricular ejection fraction of 32% and the patient was referred to stress cardiac MRI to evaluate etiology.MEDICATIONS: aspirin, atorvastatin, calcium, carvedilol, digoxin, letrozole, levothyroxine, lorazepam, spironolactone, valsartan First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact is noted. Viability/ Myocardial ScarThere is a mild mid-wall stripe pattern of late gadolinium enhancement noted in the septum. The pattern is not consistent with prior myocardial infarction and suggests the presence of underlying myocardial fibrosis.Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 116 ml/m2 (normal range: 65+/-11), the LVEDV is 246 ml (normal range 109+/-23), the LV end systolic volume index is 66 ml/m2 (normal range 18+/-5), the LVESV is 144 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 141 g. There is global hypokinesis with regional variation. No intracavitary thrombus was seen. Left AtriumThe left atrium is normal in size (90ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 88 ml/m2 (normal range 69+/-14), the RVEDV is 191 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 103 ml (normal range 35+/-13). 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 normal in size. There is a left sided aortic arch with "pseudo bovine" brachiocephalic branching pattern (normal variant).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 FindingsSmall axillary lymph nodes are 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. 3. The LV is severely dilated with mild to moderately reduced systolic function (LVEF 41%) and evidence of mild late gadolinium enhancement in the septum. The pattern is most consistent with underlying myocardial fibrosis due to dilated cardiomyopathy.4. Normal RV size with mildly reduced systolic function (RVEF 46%).5. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.