MRI CARDIAC W/FLOW W/STRESS WWO, 11/16/2016 8:15 AM First Pass PerfusionDuring hyperemia, no perfusion defects were present. Mild dark rim artifact is present. Viability/ Myocardial ScarThere is mid-myocardial late gadolinium enhancement of the septum from the mid wall to the base which represents an infiltrative process, inflammation, or fibrosis. The finding is not typical for prior myocardial infarction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 161 ml/m2 (normal range: 65+/-11), the LVEDV is 334 ml (normal range 109+/-23), the LV end systolic volume index is 133 ml/m2 (normal range 18+/-5), the LVESV is 277 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 69 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 117 ml/m2 (normal range 69+/-14), the RVEDV is 243 ml (normal range 110+/-24), the RV end systolic volume index is 97 ml/m2 (normal range 22+/-8), and the RVESV is 200 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate 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 mildly dilated. 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 dilatedVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions (right greater than left). 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. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of any vasodilator stress test is likely reduced in the face of severe LV dilation and dysfunction. 2. The left ventricle is severely dilated with severely reduced systolic function (LVEF 17%). There is evidence of myocardial fibrosis involving the mid-myocardial layer of the basal septum. This finding is not typical for prior myocardial infarction and has been commonly described in non-ischemic/ dilated cardiomyopathy. 4. The right ventricle is severely dilated with severely reduced systolic function (RVEF 17%).5. At least moderate mitral regurgitation.6. Severe biatrial enlargement.7. Mild dilation of main pulmonary artery and aortic root. 8. Small pericardial and pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.