59 year old male, status post heart transplant, stress to evaluate for transplant coronary artery disease.MEDICATIONS: Aspirin, metoprolol, pravastatin, losartan, cellcept, tacrilomus First Pass PerfusionDuring hyperemia, no perfusion defects were present.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 mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19), the LV mass index is 70 g/m2, and the LV mass is 173 g. There are no regional wall motion abnormalities present. Native myocardial T1 relaxation time is 970-1035ms (all within normal limits). Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size with mildly decreased systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 106 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant morphology.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.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 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and low normal systolic function (LVEF 50%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size with mildly reduced systolic function (RVEF 43%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.