52 year old male with history of ischemic heart disease, hypertension, dyslipidemia and smoking history presenting for cardiac evaluation. MEDICATIONS: enteric coated aspirin, rosuvastatin, carvedilol, prasugrel, ranolazine, lisinopril, fenofibrate First Pass PerfusionDuring hyperemia, there is a large perfusion defect involving the entire inferior and inferolateral walls. Additional the perfusion defect involves the basal inferoseptum. The vast majority of the perfusion defect (except the basal inferoseptum) is also seen during resting conditions and is associated with the below described large transmural myocardial infarction. Viability/ Myocardial ScarThere is a large amount of transmural late gadolinium enhancement noted suggesting prior myocardial infarction with scar in most of the the inferior and inferolateral walls. There is a non-transmural myocardial infarction involving the basal anterolateral wall. All of the territories with transmural myocardial infarction are not likely to be viable. The basal anterolateral wall has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 98 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 123 ml (normal range 47+/-19), the LV mass index is 60 g/m2, and the LV mass is 123 g. There is akinesis of most of the inferior and inferolateral walls. The basal anterolateral wall is mildly hypokinetic.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 62 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 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. There is a very large transmural myocardial infarction involving most of the inferior and inferolateral wall and is associated with akinesis. Although there is a corresponding perfusion defect during stress in this territory, it is also present during resting conditions and the territory is unlikely to be viable.2. There is a small perfusion defect during stress noted in the basal infero-septum. There is no associated myocardial infarction in this small segment and it is likely to be viable.3. There is a non-transmural infarction limited to the basal anterolateral wall, this small segment has an intermediate probability of viability. 4. The LAD territory has normal resting wall motion, is free of myocardial infarction and ischemia, and is viable.5. Normal LV size with overall moderately reduced systolic function (LVEF 38%).6. Normal RV size and systolic function (RVEF 56%).