76 year old man with recent diagnosis of asymptomatic LV dysfunction and PVC's after preoperative evaluation, here for cardiac MRI with vasodilator stress testing to rule out ischemic heart disease.MEDICATIONS: Toprol, lisinopril First Pass PerfusionDuring hyperemia, there were no perfusion defects present.Viability/ Myocardial ScarThere is high suspicion for the presence of late gadolinium enhancement in the basal inferolateral and lateral wall, the extent of which is difficult to discern due to associated wall thinning. It appears subendocardial which would suggest possible prior myocardial infarction. The remainder of the myocardium is viable.Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 137 ml/m2 (normal range: 74+/-15), the LVEDV is 287 ml (normal range 142+/-34), the LV end systolic volume index is 86 ml/m2 (normal range 25+/-9), the LVESV is 180 ml (normal range 47+/-19), the LV mass index is 41 g/m2, and the LV mass is 86 g. There is global hypokinesis with regional variation. There is asymmetric wall thickness, with notable thinning of the basal anterior, lateral and inferolateral wall, but the septal thickness is within normal limits (10mm).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).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 upper normal in size (maximal dimension 39 x 38mm in ascending aorta). 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. There is global hypokinesis with regional variation. There is asymmetric wall thickness, with notable thinning of the basal anterior, lateral and inferolateral wall, but the septal thickness is within normal limits (10mm). There is high suspicion for the presence of late gadolinium enhancement in the basal inferolateral and lateral wall, the extent of which is difficult to discern due to associated wall thinning. It appears subendocardial which would suggest possible prior myocardial infarction. The remainder of the myocardium is viable.3. Severely dilated LV size and moderate-severely reduced systolic function (LVEF 37%).4. Normal RV size and systolic function (RVEF 58%).