76 year old woman with history of ischemic cardiomyopathy with previous MI and multiple PCI, carotid stenosis, hypertension and hyperlipidemia referred for stress cardiac MRI to evaluate ischemic burden and scar. MEDICATIONS: aspirin, bisoprolol, CoQ10, simvastatin First Pass PerfusionDuring hyperemia, there was a moderate intensity perfusion defect in the basal inferior, inferoseptal, and inferolateral walls, which corresponds to the below described myocardial infarction.Viability/ Myocardial ScarThere is transmural late gadolinium enhancement noted in the basal to mid inferior, inferoseptal, and inferolateral walls; and the apical inferior wall. These territories are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is moderate-severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 196 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 109 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 67 g. There is akinesis of the basal to mid inferior wall, which was seen on the previous study. There is no LV thrombus.Left AtriumThe left atrium is moderately to severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 24 ml/m2 (normal range 22+/-8), and the RVESV is 44 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 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 a normal brachiocephalic branching pattern. There is an extremely torturous bend in the descending aorta with mild atherosclerosis.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 FindingsHigh mediastinal lymph nodes and mild thyromegaly 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. There is a large transmural myocardial infarction in the usual territory of the RCA which is associated with a perfusion defect. The territory is not likely to be viable. 2. There is no obvious myocardial infarction or ischemia in the usual territory of the LAD and LCx.3. Moderate-severely dilated LV size with mildly reduced systolic function (LVEF 44%). 4. Normal RV size and systolic function (RVEF 63%).5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.