A 61 year old male with poorly controlled hypertension, diabetes mellitus, hyperlipidemia, s/p hip replacement. Recent onset shortness of breath. Recent echocardiography showed normal left and right ventricular systolic function with concentric hypertrophy. Referred for stress cardiac MRI for further evaluation.MEDICATIONS: amlopidine, aspirin, clonidine, furosemide, olmesartan, sotalol, atorvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no late gadolinium enhancement. The entire myocardium is viable.Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 288 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 234 g. The septum measures 15 mm at the base. There is concentric left ventricular hypertrophy. There is infero-lateral wall hypokinesis from base-mid segments. T1-times of the mid to apical septum are borderline increased (~1050-1100ms). No intracavitary thrombus. No myocardial iron overload.Left AtriumThe left atrium is moderately dilated (143ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 257 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is 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 measures 42mm. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta at the level of the main PA bifurcation is 42.4mm. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.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. No perfusion defects/ "ischemia" present during hyperemia.2. There is no late gadolinium enhancement. All segments of the the myocardium are viable.3. Moderate LVH. 4. Mildly dilated LV with normal systolic function (LVEF 58%).5. Normal RV size and systolic function (RVEF 62%).6. Bilateral moderate atrial dilatation.7. Mild main PA dilatation.8. Mildly dilated aortic sinus of valsalva. See above measurements.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.