53 year old man with history of premature CAD s/p CABG in 2008 and re-do in 2009 for RIMA to OM, as well as subsequent PCI to RIMA and left main coronary, with refractory angina. He is referred for cardiac MRI with vasodilator stress testing to evaluate for ischemia.MEDICATIONS: Regadeneson 0.4mg with aminophylline 75mg First Pass PerfusionDuring hyperemia, perfusion defects are noted in the basal inferior and anterior walls; the mid anterior, anteroseptal, inferoseptal, inferior, and inferolateral walls; and the apical septal and lateral walls. Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the basal inferolateral wall which suggests prior myocardial infarction. This segment has an intermediate probability of viability; the remainder of the myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 88ml/m2 (normal range: 74+/-15), the LVEDV is 209l (normal range 142+/-34), the LV end systolic volume index is 39ml/m2 (normal range 25+/-9), the LVESV is 94ml (normal range 47+/-19), the LV mass index is 74g/m2, and the LV mass is 177g There is basal inferolateral hypokinesis. There is abnormal septal motion consistent with history of previous cardiac surgeries. Left AtriumThe left atrium is mild to moderately dilatedRight VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 74 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 trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 are sternotomy wires present with associated artefact. 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 is a large burden of ischemia as described above.2. Small non-transmural myocardial infarction involving the inferolateral wall. This segment has an intermediate probability of viability. The remainder of the entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%) with mild hypokinesis of the basal inferolateral wall.4. Normal RV size and systolic function (RVEF 61%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.