64 year old male with history of hypertension, diabetes and dyslipidemia presenting after troponin elevation during EGD study. MEDICATIONS: aspirin, simvastatin, nebivolol, losartan, hydrochlorothiazide First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no evidence of prior myocardial infarction. There is subtle diffuse uptake of late gadolinium enhancement involving much of the basal left ventricle but not the rest the ventricle. Similarly, the native T1 time at the left ventricular base is approximately 1200ms; where as, it is only 1100ms at the apex. The gadolinium kinetics based on the TI scout are unremarkable. There continues to be increased signal at the RV insertion points. Taken together, these findings suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The diagnosis of early cardiac amyloidosis should be entertained. Left VentricleThe left ventricle is normal in size with mild left ventricular hypertrophy and low normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 108 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVEDV is 148 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace 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 mildly enlarged.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. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function and mild left ventricular hypertrophy (LVEF 55%). There is subtle diffuse uptake of late gadolinium enhancement involving much of the basal left ventricle but not the rest the ventricle. Similarly, the native T1 time at the left ventricular base is approximately 1200ms; where as, it is only 1100ms at the apex. Taken together, these findings suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The diagnosis of early cardiac amyloidosis should be entertained. 4. Normal RV size and systolic function (RVEF 50%).5. Moderate left atrial dilation.6. Mild main pulmonary artery dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.