56 year old woman with history of peripheral arterial disease, diabetes who is referred for cardiac stress MRI for further evaluation of chest pain.MEDICATIONS: ASA, Lipitor, HCTZ, Xarelto, Metformin. First Pass PerfusionDuring hyperemia, there is a moderate severity perfusion defect involving the basal inferolateral wall. A subtle perfusion defect in the mid to apical inferior and inferoseptal walls can not be excluded.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 normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 128 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 63 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). 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 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 FindingsSmall axillary (<1mm) lymph nodes 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. There is a moderate severity perfusion defect/ "ischemia" in the basal inferolateral wall. A second subtle perfusion defect involving the mid to apical inferior and inferoseptal walls can not be excluded.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.