59 year old male with a history of ischemic cardiomyopathy who underwent cardiac transplant in 2012, current history of hypertension who is referred for stress cardiac MRI.MEDICATIONS: Aspirin, Atorvastatin, Gabapentin, Lisinopril, Metoprolol XL, Tacrolimus. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a mid-myocardial stripe of late gadolinium enhancement noted in the basalt to mid inferior and inferolateral walls. The pattern is atypical for prior myocardial infarction and suggests suggests the presence of fibrosis, inflammation, or infiltration.Left VentricleThe left ventricle is normal in size and systolic function. There is subtle hypokinesis of the mid inferolateral wall. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 35 g/m2, and the LV mass is 74 g. Pre-contrast native myocardial T1 relaxation times are normal (1018 ms).Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 213 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 mildly dilated. 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. There are either small bilateral infiltrates or atelectasis noted in lower lungs. 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. No perfusion defects/ "ischemia" present during hyperemia.2. There is a small amount of atypical LGE in the basal to mid inferior and inferolateral walls. The pattern is not consistent with prior myocardial infarction and suggest fibrosis, inflammation, or infiltration. If asymptomatic, this finding most likely represents an old episode of rejection. 3. Normal LV size and systolic function (LVEF 56%). 4. Normal RV size with mildly reduced systolic function (RVEF 44%).5. Mild aortic root and main pulmonary artery dilation.6. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.