76 year old man with prior PCI to LCx and RCA, referred for evaluation of chest tightness.MEDICATIONS: ASA, Lipitor First Pass PerfusionDuring hyperemia, no perfusion defects were present. There is a prominent dark rim artifact noted.Viability/ Myocardial ScarThere is a small area of late gadolinium enhancement in the basal inferolateral wall. It is mid myocardial and not consistent with prior myocardial infarction. It may be due to a prior fibrotic, inflammatory, or infiltrative process. It appears similar to prior cardiac MRI on 7/8/14. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. The interatrial septum is aneurysmal. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 59 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 trace 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 51%).5. There is a small area of late gadolinium enhancement in the basal inferolateral wall. It is not consistent with prior myocardial infarction and may be due to a prior fibrotic, inflammatory, or infiltrative process. 6. Compared to prior MRI on 7/8/14, there is no significant change.