63 year old male with recent diagnosis of LV dysfunction of unknown etiology. Referred for vasodilator stress cardiac MRI to evaluate for ischemia or infiltrative disease. History of previously reported lymphoma.MEDICATIONS: Losartan, multivitamin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 mildly dilated, with moderately reduced systolic function with regional variability. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 122 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 142 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 143 g. No intracardiac thrombus. Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 139 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 53 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. Mitral regurgitation is present. Dedicated imaging was not performed; however, by visual estimation it appears moderate in severity. 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 drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThe majority of the abdomen and pelvis are not included in the field of view. T2 hyperintense focus in the left hepatic lobe incompletely characterized. Previously described normal-sized lymph nodes on recent PET/CT are again noted. No axillary or mediastinal lymphadenopathy is detected.
1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Mildly dilated left ventricle, with moderately reduced systolic funciton (LVEF 37%).4. Normal RV size and systolic function (RVEF 62%).