65 year old male with presumed ischemic cardiomyopathy, hypertension, hyperlipidemia admitted for acute decompensated heart failure. MEDICATIONS: Outpatient medications: Aspirin, Atorvastatin, Carvediolol, Furosemide, and Lisinopril. First Pass PerfusionDuring hyperemia, there is a subtle perfusion defect of the mid lateral wall noted. There is dark rim artifact also noted. Viability/ Myocardial ScarThere is subendocardial late gadolinium enhancement noted of the apical to mid anterior and inferior walls suggesting prior myocardial infarction. This territory has intermediate probability of viability. There is near full-thickness (>75%) to full-thickness late gadolinium enhancement of the anterolateral and inferolateral walls (apex to basal) and basal anterior wall. This territory is unlikely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 144 ml/m2 (normal range: 74+/-15), the LVEDV is 279 ml (normal range 142+/-34), the LV end systolic volume index is 110 ml/m2 (normal range 25+/-9), the LVESV is 212 ml (normal range 47+/-19), the LV mass index is 66 g/m2, and the LV mass is 128 g. There are several wall motion abnormalities present. The apical to mid anterior, anterolateral, and lateral walls are hypokinetic/akinetic. The inferolateral and inferior walls are also akinetic. Additionally there is hypokinesis of the mid anteroseptum. Pre-contrast, native myocardial T1 relaxation time is normal (1010 ms) at the level of the septum. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly-moderately reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 228 ml (normal range 142+/-31), the RV end systolic volume index is 74 ml/m2 (normal range 31+/-9), and the RVESV is 142 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. Incompletely assessed mild focal thickening may relate to leaflet calcification.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least 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 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. During hyperemia, there is a subtle perfusion defect of the mid lateral wall noted. There is dark rim artifact also noted. 2. There is subendocardial late gadolinium enhancement noted of the apical to mid anterior and inferior walls suggesting prior myocardial infarction. This territory has intermediate probability of viability. There is near full-thickness (>75%) to full-thickness late gadolinium enhancement of the anterolateral and inferolateral walls (apex to basal) and basal anterior wall. This territory is unlikely to be viable. 3. The left ventricle is severely dilated with severely reduced systolic function (LVEF 24%). 4. There are several wall motion abnormalities present. The apical to mid anterior, anterolateral, and lateral walls are hypokinetic/akinetic. The inferolateral and inferior walls are also akinetic. Additionally there is hypokinesis of the mid anteroseptum. 5. The right ventricle is mildly dilated with mildly-moderately reduced systolic function (RVEF 38%).6. Mild mitral/tricuspid regurgitation.7. Moderate biatrial enlargement. 