56 year old with history of peripheral artery disease, stroke and smoking history presenting with atypical chest pain. MEDICATIONS: amlodipine, aspirin, atorvastatin, cilostozal, clopidogrel First Pass PerfusionDuring hyperemia, there is a small perfusion defect in the mid to basal septum and inferoseptal walls. 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 60%, the LV end diastolic volume index is 44 ml/m2 (normal range: 74+/-15), the LVEDV is 95 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 32 g/m2, and the LV mass is 69 g. There is subtle tardokinesis of the basal inferior wall. On the late gadolinium enhancement images, there is an increased signal involving the basal to mid septum, which likely represents partial volume artifact. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild 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. There is pericardial fat present. 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. There is a mild "ischemia" / perfusion defect during hyperemia in the RCA territory. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 60%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. There is mild tardokinesis of the basal inferior wall.4. Normal RV size and systolic function (RVEF 50%).5. Mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.