A 58 years old male with history of hypertension, stroke, aortic valve replacement more that 10 years ago, recently diagnosed with myelodysplastic syndrome. A recent echocardiography showed mild left ventricular systolic dysfunction. Referred to cardiac MRI to evaluate ischemia and viability.MEDICATIONS: Atorvastatin, Esomeprazole, Nitrates, Lisinopril, Metoprolol, Warfarin First Pass PerfusionDuring hyperemia, a large perfusion defect is noted in the mid inferior and inferolateral walls. Also small perfusion defects are noted in the mid anteroseptum and anterolateral walls. The inferior and inferolateral wall perfusion defects correspond with the below described myocardial infarction.Viability/ Myocardial ScarThere is a large transmural myocardial infarction involving the entire apex and the mid inferior and inferolateral walls. These territories are not likely to be viable. The rest of the myocardium is free of myocardial infarction and is likely to be viable.Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 212 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 114 ml (normal range 47+/-19), the LV mass index is 79 g/m2, and the LV mass is 173 g. Apical akinesis and mid-to-apical hypokinesis in the inferior and inferolateral walls is noted. No LV apical thrombus is noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size .Aortic ValveA mechanical prosthetic valve is noted in the aortic position. Mitral ValveThe mitral valve opens widely and 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 mild 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 FindingsSternal wires were noted. 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 transmural myocardial infarction which is associated with a perfusion defect and involves the LV apex and the mid inferior and inferolateral walls. This territory is not likely to be viable. 2. In addition to the myocardial infarction, there is a small amount of ischemia present in the mid anteroseptum and anterolateral wall. These segments are likely to be viable. 3. Normal LV size and mild systolic dysfunction (LVEF 46%) with a regional wall motion abnormality as described above.4. Normal RV size and systolic function (RVEF 60%).