52 year old with coronary artery disease s/p myocardial infarction who has chronic stable angina and is referred for viability assessment. MEDICATIONS: ASA, metoprolol, atorvastatin. Left VentricleThe left ventricle is moderately dilated with mild to moderately reduced systolic function. There is hypokinesis of the basal to mid inferolateral and anterolateral walls. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 264 ml (normal range 142+/-34), the LV end systolic volume index is 76 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19), the LV mass index is 92 g/m2, and the LV mass is 191 g. The basal to mid inferior and inferolateral walls and the basal anterolateral walls has evidence of a myocardial infarction which involves approximately 50% of the wall thickness. Following the administration of dobutamine 20mcg/kg/min, the overall LV ejection fraction improves. All of the segments without evidence of myocardial infarction have evidence of increased contractility. Additionally, the infarcted basal and mid inferior walls demonstrate increased contractility during dobutamine infusion. This suggests that these segments are viable. The other segments that have a myocardial infarction in them do not improve with dobutamine and are likely not viable. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 100 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. Moderate left ventricular dilation with mild to moderate reduction in systolic function (LVEF 41%).2. There is a large, nearly transmural myocardial infarction. There is evidence of viability in 2 of the 5 myocardial segments that are affected by the scar. Additionally, all of the segments that do not have evidence of myocardial infarction are also viable. 3. Normal RV size and systolic function (RVEF 52%).4. Moderate dilation of the left atrium. 