76 year old male with history of coronary artery disease, hypertension, diabetes and dyslipidemia presenting with increasing chest pain with exertionMEDICATIONS: aspirin, rosuvastatin, carvedilol, isosorbide mononitrate, irbesartan First Pass PerfusionDuring hyperemia, there are perfusion defects associated with the below described transmural myocardial infarction. None of the other territories have clear evidence of ischemia.Viability/ Myocardial ScarThere is extensive transmural late gadolinium enhancement noted likely from prior myocardial infarction in the entire septum, anterior and anteroseptal the apex and these segments are not viable. The remaining myocardium is free of myocardial infarction and these segments are viable. There is fat deposition in the septal infarct consistent with old myocardial infarction. Left VentricleThe left ventricle is mildly enlarged in size with moderate reduced systolic function. There is akinesis in the LAD territory. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 249 ml (normal range 142+/-34), the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9), the LVESV is 163 ml (normal range 47+/-19), the LV mass index is 37 g/m2, and the LV mass is 83 g. No LV thrombus is noted. Left AtriumThe left atrium is mild to moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 large transmural myocardial infarction in the LAD territory, which is not viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable.2. No evidence of ischemia in viable territories.3. Mildly enlarged LV size with moderately reduced systolic function (LVEF 35%) with akinesis of the LAD territory.4. Normal RV size and systolic function (RVEF 63%).Compared to previous study, no significant change.