64 year old female with a history of sarcoidosis, hypertension, hyperlipidemia, diabetes, ASD s/p closure in the 1970s. Referred for vasodilator stress cardiovascular MR due to new wall motion abnormality noted on recent echocardiogram.MEDICATIONS: Metformin, Amlodipine, Simvastatin, Metoprolol, Aspirin. First Pass PerfusionDuring hyperemia, non-transmural perfusion defects were noted in the basal inferolateral wall and the apical inferior, anterior, and lateral walls. The overall ischemia score is a total of 4 out of 32. Approximately 12% of the myocardium is ischemic. Viability/ Myocardial ScarThere was no prior myocardial infarction noted and the entire myocardium is viable. There is, however, a small amount of "atypical" late gadolinium enhancement in the apical anterior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. When compared to the prior study, the amount of late gadolinium enhancement is less. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 134 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 49 g/m2, and the LV mass is 94 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 86 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 moderate mitral regurgitation. The posterior leaflet is somewhat tethered.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 mildly dilated, measuring 33mm in diameter. Right pulmonary artery measures 24 mm, Left pulmonary artery measures 22 mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a shelf of calcium along the apical anterior wall, which was also previously present.Extracardiac FindingsSternal wires 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 moderate burden of mild ischemia involving the left circumflex and distal left anterior descending artery territories.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%) with evidence of a small amount of atypical (non-myocardial infarction pattern) late gadolinium enhancement involving the apical anterior wall. The burden of late enhancement is less than on the prior study.4. Normal RV size with mildly reduced systolic function (RVEF 48%), which is slightly lower than on the prior study.5. Mild dilation of the main pulmonary arteries.6. Moderate mitral regurgitation. 7. Small area of pericardial calcification along LV apex.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.