A 73 year old female with personal history of hypertension, hyperlipidemia, chronic pulmonary disease, non-obstructive coronary artery disease and mild to moderate aortic stenosis . A recent cardiac CT showed moderate calcification of the aortic valve, severe calcification of the coronary arteries and ascending aorta with a diameter of 4.1cm. Referred to stress cardiac MRI for further evaluation of shortness of breathMEDICATIONS: aspirin, atorvastatin, clopidogrel, fluticasone, singulair, omeprazole, ramipril, hydrochlorothiazide First Pass PerfusionDuring hyperemia, two distinct perfusion defect are noted. One in the basal inferolateral wall and the other in the apical inferior wall. 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/hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 117 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 33 ml (normal range 31+/-10), the LV mass index is 60 g/m2, and the LV mass is 96 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size (88ml). Right VentricleThe right ventricle is normal in size with normal/hyperdynamic systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 113 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 36 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet. There is acceleration of the flow through the aortic valve suggesting the presence of aortic valve stenosis. Correlation with echo suggested to quantify severity. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely, the leaflets are thickened and there is mild mitral regurgitation. Posterior mitral annular calcification is also noted. 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 ascending aorta is mildly dilated (40mm). The rest of the 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 mildly dilated (32mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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. Two distinct areas of ischemia are noted: one in the basal inferolateral wall and the other in the apical inferior wall. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 72%).4. Normal RV size and systolic function (RVEF 68%).5. There is aortic valve calcification and stenosis, consider echo to assess severity of aortic valve stenosis.6. There is mild mitral regurgitation.7. The ascending aorta is mildly dilated. 8. The main pulmonary artery is mildly dilatedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.