79 year old female with continued burning chest pain, prior abnormal stress. First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal anteroseptum and the mid inferoseptum, anteroseptum, anterior, and anterolateral walls. Based on the atypical distribution of the perfusion defect, the differential diagnosis includes microvascular dysfunction and epicardial coronary disease. Left VentricleThe left ventricle is normal in size and global function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 86 g. There are no regional wall motion abnormalities present. There is late gadolinium enhancement involving the basal inferior, inferoseptal, and anteroseptal walls. In the inferior wall it is in a mid-wall pattern; however, in the inferolateral and anterolateral walls it is subendocardial and involves ~50% of the wall thickness. Although this pattern is consistent with myocardial infarction, it may also represent an infiltrative process as the wall thickness is preserved.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 86 ml (normal range 110+/-24), the RV end systolic volume index is 16 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. 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 moderate 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 FindingsHiatal hernia is noted. 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 anteroseptum and the mid inferoseptum, anteroseptum, anterior, and anterolateral walls. Based on the atypical distribution of the perfusion defect, the differential diagnosis includes microvascular dysfunction and epicardial coronary disease.2. There is late gadolinium enhancement involving the basal inferior, inferoseptal, and anteroseptal walls. In the inferior wall it is in a mid-wall pattern; however, in the inferolateral and anterolateral walls it is subendocardial and involves ~50% of the wall thickness. Although this pattern is consistent with myocardial infarction, it may also represent an infiltrative process as the wall thickness is preserved.3. Normal LV size and systolic function (LVEF 66%).4. Normal RV size and systolic function (RVEF 66%).5. Moderate tricuspid regurgitation.6. Hiatal hernia is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.