66 year old with history of active smoking, hypertension and SLE with recent onset pericardial effusion requiring drainage and LV dysfunctionMEDICATIONS: carvedilol, furosemide, Bidil First Pass PerfusionDuring hyperemia, no perfusion defects were present.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 severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 243 ml (normal range 109+/-23), the LV end systolic volume index is 68 ml/m2 (normal range 18+/-5), the LVESV is 150 ml (normal range 31+/-10), the LV mass index is 70 g/m2, and the LV mass is 243 g. There is global hypokinesis with regional variation. Native myocardial T1 relaxation times are within normal limits. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 167 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild to moderately 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 normal in mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion without significant pericardial thickening or obvious increased T2-signal.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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Severe LV dilation with moderately reduced systolic function (LVEF 38%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size with mildly reduced systolic function (RVEF 46%).5. Moderate left atrial dilation. 6. Mild to moderate aortic regurgitation. 7. Trivial pericardial effusion without significant pericardial thickening or obvious increased T2-signal. 8. Mild main pulmonary artery dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.