65 year old male with CAD and complex past revascularizationMEDICATIONS: amlodipine, carvedilol, lasix, ibesartan, isosorbide, pravastatin, ranolazine, warfarin, nitro patch Viability/ Myocardial ScarThere is late gadolinium enhancement noted in the basal inferolateral wall suggesting prior myocardial infarction; approximately 70% wall thickness. Otherwise, the entire myocardium is viable. First Pass PerfusionDuring hyperemia, there is fixed perfusion defect in the mid and basal inferolateral wall. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 131 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 81 g/m2, and the LV mass is 172 g. There is a sigmoid shape to the ventricular septum. There is hypokinesis in the infero and inferolateral wall of the ventricular myocardium. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 88 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 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 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, there is fixed perfusion defect in the mid and basal inferolateral wall. 2. There is presence of late gadolinium enhancement in the basal inferolateral wall suggesting prior myocardial infarction approximately 70% of the myocardial wall. There is hypokinesis in the infero and inferolateral wall of the ventricular myocardium.3. Normal LV size and systolic function (LVEF 70%). 4. Normal RV size and systolic function (RVEF 52%).