61 year old woman with history of recently diagnosed breast cancer, hypertension, mild LV dysfunction and LBBB on ECG referred for vasodilator stress cardiac MRI to evaluate for etiologies MEDICATIONS: lisinopril First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal anterior and septal walls and the apical septal walls. Although this finding may be due to ischemia, the possibility that it is secondary to the LBBB.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 low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 101 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 87 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 86 g. There is abnormal septal wall motion abnormality due to LBBB. The native T1 myocardial relaxation time is normal (1030ms).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). 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 trivial 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 FindingsThyroid enlargement involvement. 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. During hyperemia, a perfusion defect is noted in the basal anterior and septal walls and the apical septal walls. Although this finding may be due to ischemia, the possibility that it is secondary to the LBBB must also be considered.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and lower normal systolic function (LVEF 53%).4. Normal RV size and mildly reduced systolic function (RVEF 47%).5. Left atrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.