65 year old man with history of HTN, new LV dysfunction and rectal cancer referred for stress MR as part of ischemic evaluation.MEDICATIONS: carvedilol, lisinopril, aspirin, spironolactone First Pass PerfusionDuring hyperemia, there were no perfusion defects observed.Viability/ Myocardial ScarThere was a prominent mid-wall stripe pattern of late gadolinium enhancement which is atypical for previous myocardial infarction, seen in the basal to mid septum, and inferior wall. This has been described in dilated cardiomyopathy. No evidence for previous myocardial infarction.Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 147 ml/m2 (normal range: 74+/-15), the LVEDV is 238 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 150 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 116 g. There is borderline LVH (wall thickness of 10-11mm). There is global hypokinesis with regional variation, but notable abnormalities in the regions associated with late gadolinium enhancement as above.Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 117 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely, is trileaflet, and there is qualitatively moderate aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered with thickening of the leaflet tips. There is mild mitral regurgitationPulmonic 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 with stress.2. No prior myocardial infarction, however there is a prominent pattern of mid-wall late gadolinium enhancement throughout the basal-mid septum and basal-mid inferior wall with associated significant wall motion abnormalities. While this has been described in dilated cardiomyopathy, this could also suggest infiltrative, inflammatory or fibrotic disease. 3. Severely dilated LV size with moderate-severely reduced systolic function (LVEF 37%).4. Normal RV size and mildly reduced systolic function (RVEF 46%).5. At least moderate aortic regurgitation with a trileaflet aortic valve.6. Mitral valve tethering with mild mitral regurgitation.7. Biatrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.