63 year male with history of past NSTEMI, cardiomyopathy, HTN, CVA who presents for stress cardiac MRI to evaluate for ischemic etiology of cardiomyopathy.MEDICATIONS: aspirin, lisinopril, metoprolol bid, pravastatin, thiamine, ferrous sulfate First Pass PerfusionDuring hyperemia, there is a moderate sized defect of moderate severity of most of the inferior wall. Viability/ Myocardial ScarThere are two patterns of late gadolinium enhancement noted. The first is a transmural myocardial infarction involving most of the inferior wall. This territory is not viable. The second is a diffuse mid-myocardial late gadolinium enhancement in the anteroseptal, inferoseptal, anterolateral, and inferolateral walls suggestive of fibrosis, inflammation, or infiltration. This pattern is not consistent with prior myocardial infarction. Left VentricleThe left ventricle is severely enlarged with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 138 ml/m2 (normal range: 74+/-15), the LVEDV is 246 ml (normal range 142+/-34), the LV end systolic volume index is 92 ml/m2 (normal range 25+/-9), the LVESV is 163 ml (normal range 47+/-19), the LV mass index is 74 g/m2, and the LV mass is 131 g. There is global hypokinesis with additional akinesis of most of the inferior wall. There is no LV thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 229 ml (normal range 142+/-31), the RV end systolic volume index is 83 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild 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 trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated. The sinus of Valsalva is 41 mm in diameter.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. During hyperemia, there is a perfusion defect which involves most of the inferior wall. These segments are also thinned, akinetic and has a transmural myocardial infarction. This territory is unlikely to be viable. 2. There is also a pattern of mid-myocardial late gadolinium enhancement in the anteroseptal, inferoseptal, anterolateral, and inferolateral walls suggestive of fibrosis, inflammation, or infiltration. This suggests that the patient has both an ischemic and non-ischemic component to his cardiomyopathy.3. The left ventricle is severely enlarged with moderately reduced systolic function [LVEF 33%]. There is akinesis and scarring of the basal to mid inferior wall. 4. The right ventricle is mildly dilated with moderately reduced systolic function[RVEF 33%]5. Mild aorta root dilation with mild aortic regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.