83 year old male with history of CAD with CABG, chronic angina and hypertension referred for dobutamine viability cardiac MRI testing.MEDICATIONS: aspirin, atorvastatin, carvedilol, isosorbide dinitrate, lisinopril, ranolazine, furosemide Viability/ Myocardial ScarThere is transmural late gadolinium enhancement in the basal inferoseptum and inferior walls. These segments are not likely to be viable. The myocardial infarction is non-transmural in the basal inferolateral wall and contractility in this segment improves following the administration of 20mcg/kg/min of dobutamine suggesting that this segment is viable. The mid-ventricular inferior and inferolateral walls have a transmural myocardial infarction and are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is thinning and akinesis of the above described segments with myocardial infarction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 137 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 28 g/m2, and the LV mass is 46 g.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 58 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 trace mitral regurgitation. There is mild thickening of the tip of the anterior leaflet.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 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 FindingsSternotomy wires are present. 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. There is a large, predominantly transmural myocardial infarction in the usual territory of the right coronary artery. Only a small portion of this infarcted territory has evidence of viability. The other coronary territories are free of myocardial infarction and likely to be viable. 2. Normal LV size and mildly reduced systolic function (LVEF 46%) with akinesis of the above described infarcted myocardium.3. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.