52 year old man with myositis, diabetes, hypertension, hyperlipidemia, and coronary artery disease previously treated with a stent presenting with recurrent angina. He is referred to rule out ischemia.MEDICATIONS: aspirin, clopidogrel, ezetimibe, lisinopril, First Pass PerfusionDuring hyperemia, a mild perfusion defect involving the apical anterior, lateral, inferior, and septal walls was noted. The overall ischemia score is 4 out of a possible 32 and 12% of the myocardium was 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 viableLeft VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. There is mild circumferential LVH (IVSd=12mm). The overall LV ejection fraction is 43%, the LV end diastolic volume index is 123 ml/m2 (normal range: 74+/-15), the LVEDV is 257 ml (normal range 142+/-34), the LV end systolic volume index is 70 ml/m2 (normal range 25+/-9), the LVESV is 147 ml (normal range 47+/-19), the LV mass index is 99 g/m2, and the LV mass is 207 g. There is abnormal septal motion consistent with the patient's known left bundle branch block. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 97 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.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 mild ischemia in the usual distribution of the mid to distal left anterior descending artery. 2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate LV dilation and mild LVH with mildly reduced systolic function (LVEF 43%) without evidence of underlying myocardial fibrosis.4. Normal RV size and systolic function (RVEF 54%).5. Moderate left atrial dilation. 6. Mild mitral and tricuspid regurgitation. 7. Mild main pulmonary artery dilation. 8. Small pericardial effusion. 