74Yrs-old male with a history of CAD s/p failed PCI of PDA In 2004, admitted with dyspnea and new LV dysfunction, referred for ischemic evaluation.MEDICATIONS: ASA, losartan, nifedipine, coreg, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is present. Viability/ Myocardial ScarThere is a mid myocardial stripe of late gadolinium enhancement in the basal to mid septum. This pattern is not typical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The "mid wall stripe" pattern can be seen in non-ischemic dilated cardiomyopathies.Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 211 ml (normal range 142+/-34), the LV end systolic volume index is 86 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 137 g. LV dysfunction is global.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 111 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is apically displaced due to bi-leaflet tethering. There is trace 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 moderately dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSee recent CT for lung findings. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction.3. Mildly dilated LV with severely reduced systolic function (LVEF 26%). There is a pronounced mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum. The pattern is atypical for prior myocardial infarction and most likely represents myocardial fibrosis. It has been commonly described in dilated cardiomyopathy.4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.