57 year old male with known CAD, found to have chronic total occlusion of OM and diagonal coronary artery, stress being done to evaluate for ischemic tissue and myocardial viabilityMEDICATIONS: amlodipine, aspirin, atorvastatin, isosorbide mononitrate, metoprolol Stress PerfusionDuring dobutamine infusion, no wall motion abnormalities were present. Viability/ Myocardial ScarThere was presence of late gadolinium enhancement in the basal inferolateral wall of the left ventricular myocardium, suggestive of prior myocardial infarction. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and global function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 78 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. . Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is %, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.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 FindingsSmall hepatic and left renal cysts. 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. There are no wall motion abnormalities seen during dobutamine stress. The entire myocardium is viable.2. There is presence of late gadolinium enhancement in the basal inferolateral wall of the left ventricular myocardium, suggestive of prior myocardial infarction. 3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 60%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.