55 year old man with new bi-ventricular heart failure, referred for further evaluation of heart failure etiology. MEDICATIONS: ASA, Lipitor, Coreg, Lasix, Lisinopril, insulin, Xarelto, Aldactone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no evidence of myocardial infarction; however, there is a prominent mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern is not consistent with prior myocardial infarction and is a well described finding secondary to myocardial fibrosis in patients with dilated cardiomyopathy. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 252 ml (normal range 142+/-34), the LV end systolic volume index is 92 ml/m2 (normal range 25+/-9), the LVESV is 205 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 127 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is moderately dilatedRight VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 119 ml/m2 (normal range 82+/-16), the RVEDV is 267 ml (normal range 142+/-31), the RV end systolic volume index is 86 ml/m2 (normal range 31+/-9), and the RVESV is 192 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilatedAortic ValveThe aortic valve opening is restricted with evidence of flow acceleration suggestive of aortic stenosis. Correlate with echocardiography to determine the severity. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a psuedo-bovine brachiocephalic branching pattern (normal variant).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 a trace pericardial effusion.Extracardiac FindingsSmall bilateral pleural effusions. 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 prominent mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern is not consistent with prior myocardial infarction and is a well described finding secondary to myocardial fibrosis in patients with dilated cardiomyopathy. 3. The left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 19%.4. The right ventricle is mildly dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 27%.5. At least moderate tricuspid regurgitation.6. See extracardiac findings above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.