78 year old man with new diagnosis of heart failure, referred for further evaluation of underlying etiology. MEDICATIONS: Lipitor, Lasix, Lisinopril, Xarelto, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact is noted. Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction; however, there is late gadolinium enhancement in a midwall septal stripe pattern and in a right ventricular insertion point pattern. These findings suggest the presence of underlying myocardial fibrosis and are consistent with the diagnosis of non-ischemic cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 229 ml/m2 (normal range: 74+/-15), the LVEDV is 530 ml (normal range 142+/-34), the LV end systolic volume index is 197 ml/m2 (normal range 25+/-9), the LVESV is 455 ml (normal range 47+/-19), the LV mass index is 135 g/m2, and the LV mass is 312 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 160 ml/m2 (normal range 82+/-16), the RVEDV is 371 ml (normal range 142+/-31), the RV end systolic volume index is 117 ml/m2 (normal range 31+/-9), and the RVESV is 270 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is severe aortic regurgitation, with calculated regurgitant fraction of 56%.Mitral ValveThe mitral valve opens widely with moderate 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is a trivial pericardial effusion.Extracardiac FindingsSmall 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 perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of vasodilator stress testing in patients with severe LV dysfunction may be reduced. 2. No prior myocardial infarction. There is evidence of myocardial fibrosis in the septal mid-wall stripe pattern. There is also fibrosis involving the anterior and inferior right ventricular insertion point. These findings all support the diagnosis of non-ischemic dilated cardiomyopathy.3. Severe LV dilation with severely reduced systolic function (LVEF 14%).4. Severe RV dilation with severely reduced systolic function (RVEF 27%).5. Severe aortic regurgitation.6. Moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.