65years old, gentleman, with a history of coronary artery disease status post stents, is referred for cardiac MRI due to dyspnea to evaluate cardiac function and perfusion.MEDICATIONS: Aspirin, Lisinopril, metformin, metoprolol, Nitroglycerin, Xarelto, and rosuvastatin. First Pass PerfusionDuring hyperemia, perfusion defects were noted in the basal inferoseptum and the mid inferior wall. Additionally, a large perfusion defect (corresponding to the below described myocardial infarction) was noted in the basal to mid anterior wall & mid anterolateral and inferolateral walls.Viability/ Myocardial ScarThere is a large myocardial infarction involving basal to mid anterior wall and the the mid mid anterolateral and inferolateral walls. The basal anterior wall is transmurally infarcted and that segment is not likely to be viable . The mid anterior, anterolateral, and inferolateral walls are non-transmurally infarcted and have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is a large region of akinesis and myocardial thinning involving the basal to mid anterior wall and the mid anterolateral and inferolateral walls, which corresponds to the above described myocardial infarction. There is additionally mild tardokinesis of the basal inferior wall. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 132 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 109 g. No LV apical thrombus is noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 59 ml/m2 (normal range 82+/-16), the RVEDV is 128 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 50 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 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.Extracardiac FindingsSeveral hepatic cysts are noted. 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 are 2 perfusion defects. The first involves the basal inferoseptal and mid inferior walls. This defect is associated with a subtle wall motion abnormality but no underlying myocardial infarction and the territory is likely to be viable. The second defect is larger and is more likely to be due to the large underlying myocardial infarction rather than ischemia. It involves the basal to mid anterior wall and the mid anterolateral and inferolateral walls. This territory has an intermediate probability of viability. 2. Normal LV size with mildly reduced systolic function (LVEF 45%) with regional wall motion abnormalities as described above.3. Normal RV size and systolic function (RVEF 61%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.