70 year old man with history of AML s/p chemotherapy and recent LV dysfunction, as well as atypical chest pain, referred for cardiac MRI with vasodilator stress testing.MEDICATIONS: Furosemide, lisinopril, rivaroxaban First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no 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 normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 103 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 109 g. There is extrinsic compression of the inferolateral wall by the diaphragm. Otherwise, there is global hypokinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with low-normal systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 106 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 bovine brachiocephalic branching pattern. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm at the level of the ascending aorta)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is an SVC catheter present. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is left hemidiaphragm elevation. There is a chest wall Port-A-Cath. 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.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 48%). Extrinsic compression on the lateral wall of the left ventricle by the elevated left hemidiaphragm.4. Normal RV size and low-normal systolic function (RVEF 47%).5. Severe left atrial dilation.6. Mild main pulmonary artery dilation. 