80 year old woman with history of exertional angina, peripheral and carotid arterial disease, hypertension and atrial fibrillation who presents for evaluation of worsening of her chronic angina.MEDICATIONS: aspirin, felodipine, metoprolol, losartan, niacin, lasix, labetalol, omega 3 fatty acid First Pass PerfusionDuring hyperemia, there was a mild perfusion defect noted in the basal to mid inferoseptum and inferior wall. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 71 g/m2, and the LV mass is 121 g. There are no regional wall motion abnormalities present. The native myocardial relaxation T1 time using endocardial mapping is 1110ms, which is mildly elevated and suggestive of a diffuse underlying fibrotic or infiltrative process. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 114 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve opens widely and there is trivial 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. Mild perfusion defect in the basal to mid inferior wall and inferoseptum.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and low-normal systolic function (LVEF 52%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.