a 53 years old female with history of coronary artery disease with a CABG in 2006 (LIMA to CX, RIMA to LAD) and 2008 (SVG to DG, RI and OM1) with multiple PCI presenting with increasing dyspnea, referred to cardiac MR for evaluation of ischemia.MEDICATIONS: Aspirin, prasugrel, Atorvastatin, Metoprolol, Amlodipine, Pletal First Pass PerfusionDuring hyperemia, there is a perfusion defect (ischemia) throughout most of the basal to mid inferior/inferolateral and inferoseptal walls. There is also a perfusion defect noted in the apical septum and possibly lateral wall. The perfusion defect score is 12/32, representing 37% of the myocardium. The perfusion defect is decreased compared to prior stress MRI on 1/13/15.Viability/ Myocardial ScarThere is an area of subendocardial late gadolinium enhancement noted in the basal inferolateral wall. It is non-transmural throughout most of its length, occupies about 50% of the myocardial thickness and is suggestive of a prior myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. This area is unchanged from prior stress MRI in 1/13/15.Left VentricleThe left ventricle is upper normal in size with normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 54 g/m2, and the LV mass is 110 g. There is akinesis of the basal to mid inferolateral wall (with associated myocardial thinning). There is basal to mid inferior/inferoseptal hypokinesis. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least 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 mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. 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. During hyperemia, there is a perfusion defect (ischemia) throughout most of the basal to mid inferior/inferolateral and inferoseptal walls. There is also a perfusion defect noted in the apical septum and possibly lateral wall. The perfusion defect score is 12/32, representing 37% of the myocardium. The perfusion defect is decreased compared to prior stress MRI on 1/13/15.2. There is an area of subendocardial late gadolinium enhancement noted in the basal inferolateral wall. It is non-transmural throughout most of its length, occupies about 50% of the myocardial thickness and is suggestive of a prior myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. This area is unchanged from prior stress MRI in 1/13/15.3. The left ventricle is upper normal in size with normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 55%. There is akinesis of the basal inferoseptum and the mid lateral wall (with associated myocardial thinning)4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%5. Mild to moderate mitral and mild tricuspid regurgitation.6. Extra-cardiac findings as above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.