67 year old male with a history of hypertension, smoker with exertional dyspnea, new diagnosis of heart failure with reduced ejection fraction. MEDICATIONS: Atorvastatin, Furosemide, Lisinopril, Metoprolol First Pass PerfusionDuring hyperemia, no perfusion defects were present. The basal segment are not well visualized. Viability/ Myocardial ScarThere was small area of sub-endocardial late gadolinium enhancement of the apical to mid inferior wall suggesting prior myocardial infarction. These territories have an intermediate probability of viability. Additionally there is a mid-wall stripe of late gadolinium enhancement of the mid to basal septal, inferior walls that is not typical of infarction and may represent a second process such as myocarditis, inflammation, fibrosis, or infiltrative disease.Left VentricleThe left ventricle is severely dilated and with severely reduced ejection fraction. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 194 ml/m2 (normal range: 74+/-15), the LVEDV is 311 ml (normal range 142+/-34), the LV end systolic volume index is 127 ml/m2 (normal range 25+/-9), the LVESV is 204 ml (normal range 47+/-19), the LV mass index is 40 g/m2, and the LV mass is 63 g. There is severe hypokinesis of the apical inferior and mid inferior, inferolateral, and lateral walls.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with low-normal ejection fraction. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is at least mild-moderate aortic regurgitation. The regurgitation is eccentric. There is thickening and calcification of the aortic valve. 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 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. The left ventricle is severely dilated and with severely reduced ejection fraction (LVEF 34%). 3. There is severe hypokinesis of the apical inferior and mid inferior, inferolateral, and lateral walls.4. There was small area of sub-endocardial late gadolinium enhancement of the apical to mid inferior wall suggesting prior myocardial infarction. These territories have an intermediate probability of viability. Additionally there is a mid-wall stripe of late gadolinium enhancement of the mid to basal septal, inferior walls that is not typical of infarction and may represent a second process such as myocarditis, inflammation, fibrosis, or infiltrative disease.5. The right ventricle is normal in size with low-normal ejection fraction (RVEF 53%). 6. There is at least mild-moderate aortic regurgitation. The regurgitation is eccentric. There is thickening and calcification of the aortic valve. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.