62 year old woman with history of OHT, PCI to RCA in June 2015, referred for cardiac stress MRI for interval follow up post PCI.MEDICATIONS: Eliquis, ASA, Plavix, Lipitor, insulin, Prograf, Cellcept, Prednisone First Pass PerfusionDuring hyperemia, a perfusion defect is seen in the basal inferior and inferoseptal walls. This defect is related to the below described myocardial infarction and does not represent ischemia. A prominent dark rim artifact is noted in the mid-ventricle.Viability/ Myocardial ScarThere is an area of subendocardial late gadolinium enhancement noted in the basal to mid inferior wall, similar to prior MRI. This extends to ~50% of the myocardial thickness, consistent with prior nearly transmural myocardial infarction; this segment has a low probability of viability. The remaining myocardium is viable. There is additionally a small region of late gadolinium enhancement which involves the apical anterior wall and spares the endocardium. This "patch" of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing or infiltrative process such as prior rejection or myocarditis, and is unchanged from prior.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is hypokinesis of the basal inferior wall. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 115 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10), the LV mass index is 50 g/m2, and the LV mass is 102 g. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is mild to moderate atheromatous disease of the descending thoracic aorta.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 FindingsSternal wires are present. 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 nearly transmural myocardial infarction and an associated myocardial perfusion defect involving the basal to mid inferior wall. There is no evidence of ischemia beyond the myocardial infarction in this territory. 2. Normal LV size with mildly reduced systolic function (LVEF 46%) with evidence of mild hypokinesis in the basal inferior wall. Once again, an atypical (non-myocardial infarction) pattern of late gadolinium enhancement involving the apical anterior wall is noted, which likely represents fatty infiltration from an episode of prior rejection. 3. Normal RV size and systolic function (RVEF 63%). There is a slight improvement in LVEF when compared to the prior study from 5/6/2014. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.