A 41 year old female with hypertension, sickle cell trait, and mildly reduced left ventricular systolic function referred to stress cardiac MRI for evaluation of etiology.MEDICATIONS: Amlodipine, Aspirin, Carvedilol, Dapsone, Plaquenil, Prednisone First Pass PerfusionDuring hyperemia, no perfusion defects were present. A black ring was noted at the base, mid and apex both in stress and rest, thus this finding most probably represents an artefact.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 moderately dilated with mild systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 185 ml (normal range 109+/-23), the LV end systolic volume index is 55 ml/m2 (normal range 18+/-5), the LVESV is 97 ml (normal range 31+/-10), the LV mass index is 72 g/m2, and the LV mass is 125 g. There is mild global hypokinesis with some regional variation.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with borderline reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 165 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 85 ml (normal range 35+/-13). 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 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 are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is probably thyroid enlargement, recommend correlation with exam or ultrasound. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate LV dilation with mildly reduced systolic function (LVEF 48%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and borderline reduced systolic function (RVEF 49%).5. See extra-cardiac findings