59 year old with history of stem cell transplant for MDS, HTN, atrial fibrillation and admission for heart failure presenting for ischemic evaluation. MEDICATIONS: ASA, lisinopril, metoprolol, lasix, diltiazem First Pass PerfusionDuring hyperemia, no perfusion defect is noted. 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 mildly reduced systolic function. The overall LV ejection fraction is 46%; however, the ejection fraction measurement is limited by atrial fibrillation. The LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 250 ml (normal range 142+/-34), the LV end systolic volume index is 79 ml/m2 (normal range 25+/-9), the LVESV is 135 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 129 g. The LV dysfunction is global. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 213 ml (normal range 142+/-31), the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9), and the RVESV is 104 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately dilated.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 a small to moderate size pericardial effusion present along the posterior aspect of the LV and also over the right atrium. The pericardial effusion is not hemodynamically significant. 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 evidence of perfusion defect during hyperemia/ "ischemia"2. No prior myocardial infarction. The entire myocardium is viable.3. Moderately dilated left ventricle with mildly reduced systolic function (LVEF 46%).4. Mildly dilated RV size with normal systolic function (RVEF 51%).5. Small to moderate sized, posteriorly located pericardial effusion, without evidence of hemodynamic significance.