69 year old male with a history of coronary artery disease (STEMI in 3/2016) with incomplete revascularization of the right coronary artery (balloon angioplasty without stent placement), hyperlipidemia, HIV who is referred for stress cardiac MRI for shortness of breath. MEDICATIONS: Aspirin, Atorvastatin, Plavix, Metoprolol XL, anti-retroviral therapy First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the basal to mid inferior and inferoseptal walls. The perfusion defect extends beyond the below described myocardial infarction and represents a moderate amount of peri-infarct ischemia. Viability/ Myocardial ScarThere is a moderate sized myocardial infarction involving the basal in mid inferior wall. Parts of the infarct are transmural and non-viable; where as, other portions are non-transmural and have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 30 g/m2, and the LV mass is 52 g. There is hypokinesis of the basal to mid inferoseptal and inferior walls. The global pre-contrast native myocardial T1 relaxation time is normal (1020 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mild reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 121 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMild, bilateral atelectasis. 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. There is a myocardial infarction involving the basal to mid inferior wall which has an intermediate probability of viability. There is additionally a moderate amount of peri-infarct ischemia which extends beyond the infarcted territory and is viable.2. The remainder of the myocardium is free of myocardial infarction and is viable. 3. The left ventricle is normal in size with mildly reduced systolic function (LVEF 48%) with evidence of a wall motion abnormality as described above.4. The right ventricle is normal in size with mild reduced systolic function (RVEF 40%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.