54 year-old female with CAD s/p PCI to LAD in 3/2015, RCA CTO s/p PCI in 12/2015 and 4/2016, LV dysfunction, hypertension, OSA with chest pain.MEDICATIONS: Aspirin, Atorvastatin, Bumex, Carvediolol, Clopidogrel, Gabapentin, Hydroxychloroquine, Isosorbide mononitrate, Prednisone, Ranolazine, Spironolactone, Valsartan First Pass PerfusionDuring hyperemia, possible mild perfusion defect noted at the mid inferior segment. No significant perfusion defects noted. Stress perfusion study improved when compared with previous performed 3/2016.Viability/ Myocardial ScarDiffuse subendocardial LGE extending from the base to mid inferior wall. This was noted in the previous study from 3/2016. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size in function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 170 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 72 g. Basal to mid inferior wall hypokinesis (mild). Pre-contrast T1 mapping = 973 msLeft AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size in function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in sized. 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 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 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. During hyperemia, possible mildmid inferior wall perfusion defect. This defect is much improved from previous stress MRI dated 3/3016.2. Diffuse area of LGE extending from the base to mid inferior wall. This was noted on the previous study and is still present. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%). Basal inferior wall hypokinesis (mild)4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.