73 year old diabetic male with history of multivessel CAD by previous catheterization with ongoing chest pain, and recent normal pharmacologic SPECT stress test. He was referred for vasodilator stress CMR to evaluate for possible ischemia. MEDICATIONS: aspirin, atorvastatin, bisoprolol, candesartan, glimepiride, metformin First Pass PerfusionDuring hyperemia, a small, mild perfusion defect is noted in the mid inferolateral wall. The overall myocardial ischemic burden is 3%.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 normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 35 ml/m2 (normal range: 74+/-15), the LVEDV is 71 ml (normal range 142+/-34), the LV end systolic volume index is 14 ml/m2 (normal range 25+/-9), the LVESV is 28 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 96 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. There is lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 40 ml/m2 (normal range 82+/-16), the RVEDV is 82 ml (normal range 142+/-31), the RV end systolic volume index is 16 ml/m2 (normal range 31+/-9), and the RVESV is 33 ml (normal range 54+/-17).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 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 significant epicardial fat noted.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 small amount of mild ischemia in the mid inferolateral wall. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 59%).5. There is lipomatous hypertrophy of the inter-atrial septum. 6. Moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.