52 year old male with history of stage IV CLL with suspected transformation to B-cell lymphoma who presents for stress cardiac MRI for further evaluation of newly identified heart failureMEDICATIONS: Carvedilol, Lisinopril, Lasix IV, Acyclovir, Levaquin, Decadron, Diflucan, Zoloft First Pass PerfusionDuring hyperemia, there is no definitive evidence of perfusion defect. A prominent dark rim artifact is present, reducing the diagnostic sensitivity of the test.Viability/ Myocardial ScarThere was no obvious 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 severely reduced in systolic function and severely increased in size . The overall LV ejection fraction is 28%, the LV end diastolic volume index is 145 ml/m2 (normal range: 74+/-15), the LVEDV is 225 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 161 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 142 g. There is global hypokinesis with regional variation.Left AtriumThe left atrium is moderately increased. Right VentricleThe right ventricle is moderately reduced in systolic function and normal in size . The overall RV ejection fraction is 35%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 99 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 65 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 a small pericardial effusion.Extracardiac FindingsThere is a large burden of mediastinal lymphadenopathy. Moderate bilateral pleural effusions. 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. No obvious perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Severely increased LV size and severely reduced systolic function (LVEF 28%) without evidence of obvious myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and moderately reduced systolic function (RVEF 35%).5. Moderate left atrial dilation.6. See extra-cardiac findings. 