60-year-old male with coronary artery disease, coronary artery bypass graft ('98, redo '03), also with PCI, and angina. Referred for cardiac MRI to assess for any region of new ischemia for possible intervention. Left Ventricle (Resting Condition)The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%. The LVEDV is 206 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 99 ml (normal range 47+/-19) and the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9). The LV mass is 59 g (normal range 164+/-36) and the LV mass index is 26 g/m2 (normal range 85+/-15). There is (1) thinning and akinesis of the basal to mid inferior and inferolateral walls. There is additionally (2) a small focal area of akinesis and myocardial thinning involving the mid anterolateral wall. Myocardial ScarThere is a nontransmural myocardial infarction involving the basal anterior and anterolateral segments. There is a transmural myocardial infarction involving the mid anterolateral segment. There is a transmural myocardial infarct involving the basal inferior and inferolateral segments. There is a nontransmural myocardial infarction involving the mid inferior and inferolateral segments. Dobutamine ResponseDuring low dose dobutamine infusion and peak dose dobutamine infusion, the overall left ventricular systolic function increases in a stepwise fashion. There is a partial increase in contractility noted in the basal to mid inferior and inferolateral walls at low dose dobutamine; however, at peak dose dobutamine, the contractility decreases back down to baseline levels. The small focal area of akinesis involving the mid anterolateral wall does not improve at any stages of dobutamine. The remainder of the myocardium augments appropriately at peak stress. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 148 ml (normal range 142+/-31), RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVESV is 70 ml (normal range 54+/-17), and the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9).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 FindingsSternal wires are noted. Right hemidiaphragm is elevated. 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.The basal to mid inferior and inferolateral segments have evidence of partial ischemia and viability. The remainder of the myocardium is not ischemic. The basal anterior and anterolateral segments have a non-transmural myocardial infarction and are likely viable. The mid anterolateral segment has a transmural myocardial infarction and is not likely viable. 2.Normal left ventricular size with low normal systolic function. LVEF 52%.3.Normal right ventricular size and systolic function. RVEF 53%.4.Elevated right hemidiaphragm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.