54 year old man with history of non-Hodgkin's lymphoma with previous chest radiation, coronary disease with multivessel CAD with worsening LV function and exertional dyspnea, referred for cardiac MRI stress test.MEDICATIONS: aspirin, plavix, crestor, diovan, lasix, coreg First Pass PerfusionDuring hyperemia, there was a moderate to severe perfusion defect noted in the basal inferoseptum, basal inferior and mid inferior wall. The perfusion defect extends beyond the below described myocardial infarction.Viability/ Myocardial ScarThere was subendocardial late gadolinium enhancement noted in the basal inferior and inferoseptal walls in a pattern suggestive of previous myocardial infarction. It involves 50% or less of the myocardial wall, suggesting intermediate probability of viability. The remaining myocardium is viable.Left VentricleQualitatively, there is moderate left ventricular dilation with mild to moderate reduction in systolic function. There is thinning and hypokinesis of the basal and mid inferior wall.Left AtriumThe left atrium is mildly dilated. Right VentricleQualitatively, the right ventricle is normal in size and systolic function. Right AtriumThe right atrium is small, with extrinsic compression from the elevated right hemidiaphragm.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 FindingsSternotomy wires are present. The right hemidiaphragm is elevated. 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 non-transmural myocardial infarction involving the basal inferoseptum and inferior walls which is associated with a significant amount of peri-infarct ischemia and hibernating myocardium. The infarcted territories have an intermediate probability of viability. The remaining myocardium is free of myocardial infarction and likely to be viable. 2. Moderate LV dysfunction with mild to moderate reduction in systolic function. 3. Normal RV size and systolic function.4. See extra-cardiac findings.5. Quantification of ventricular size and function to follow as an addendum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.