62 year old man with angina and multivessel coronary disease is referred to evaluate for ischemic territory prior to possible revascularization.MEDICATIONS: allopurinol, aspirin, atorvastatin, colchicine, ezetimibe, isosorbide mononitrate and levothyroxine. First Pass PerfusionDuring hyperemia, there is are 2 distinct perfusion defects. The first involves the basal anteroseptum, mid anteroseptum & inferoseptum, and apical septum. The second involves the mid inferolateral wall. The overall ischemia score is 5 out of 32. Approximately, 15% of the myocardium is ischemic.Viability/ Myocardial ScarThere are two separate areas of late gadolinium enhancement in a pattern consistent with prior myocardial infarction. The first is non-transmural and involves the basal to mid inferolateral wall. These segments have an intermediate probability of viability. The second is small involves the apical inferior wall. It is transmural and that small myocardial segment is not likely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19), the LV mass index is 64 g/m2, and the LV mass is 135 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 and systolic function. The overall RV ejection fraction is 57 %, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 68 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. There is a large burden of ischemia involving the usual territory of the LAD and LCx.2. The LAD territory has a small transmural myocardial infarction in the distal most territory; however, the majority of the LAD territory is viable. 3. The LCx territory has a non-transmural myocardial infarction and has an intermediate probability of viability. 3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.