76 year old man with history of coronary artery disease complicated by myocardial infarction and treated with bypass surgery (LIMA to LAD, SVG to diagonal, SVG to OM). He presents with atypical chest pain and referred to rule out ischemia.MEDICATIONS: aspirin, atorvastatin, furosemide, metoprolol, nitroglycerin PRN. First Pass PerfusionDuring hyperemia, a borderline perfusion defect was noted in the basal anterior, basal septal, and mid septal walls. The overall ischemia score is 3 out of 32 and 9% of the myocardium is ischemic.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 and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 154 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 50 g/m2, and the LV mass is 105 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The aortic valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 FindingsSternal wires are noted. A small hepatic cyst/ hemangioma is 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. During hyperemia, there is a borderline perfusion defect/ "ischemia" which involves the basal anterior, basal anteroseptal, and mid anteroseptal walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 67%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 57%).5. Moderate tricuspid regurgitation.6. Moderate right atrial dilation.