58 year old man with left bundle branch block and paroxysmal atrial fibrillation referred to evaluate for ischemia. First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction. However there is mild epicardial late gadolinium enhancement involving the basal inferior wall suggesting that there is a degree of myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 93 g. There is abnormal septal motion related to LBBB. Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is normal in size and systolic function . The overall RV ejection fraction is 54%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 90 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 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.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 and systolic function (LVEF 66%) with evidence of mild late gadolinium enhancement in a pattern that is atypical for prior myocardial infarction but suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The pattern is non-specific but may represent old myocarditis among other possibilities.4. Normal RV size and systolic function (RVEF 54%).