53 year old man with history of CAD, with multiple PCI, referred for cardiac MRI for evaluation of chest pain and shortness of breath.MEDICATIONS: ASA, Plavix, lisinopril, Toprol XL, amlodipine, Cellcept, prednisone, methotrexate. First Pass PerfusionDuring hyperemia, has a severe perfusion defect involving the basal inferolateral, mid anterolateral and inferolateral, and apical inferior and lateral walls. The overall ischemia score is 8 out of a possible 32 and 25% of the myocardium is ischemic. 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 moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 278 ml (normal range 142+/-34), the LV end systolic volume index is 77 ml/m2 (normal range 25+/-9), the LVESV is 154 ml (normal range 47+/-19), the LV mass index is 97 g/m2, and the LV mass is 195 g. Abnormal septal wall motion due to patient's underlying left bundle branch block. There is mild LVH. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 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 severe perfusion defect in the usual territory of the left circumflex artery. 2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.