48 year old with cardiomyopathy, hypertension, diabetes and daily illicit drug use presenting for evaluation of cardiomyopathy. MEDICATIONS: carvedilol, furosemide, lisinopril, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted at rest and stress.Viability/ Myocardial ScarThere is an area of transmural late gadolinium enhancement noted in the basal inferior and inferolateral walls. The pattern is most consistent with prior myocardial infarction; however, because the late gadolinium enhancement is associated with preserved myocardial wall thickness, the possibility of an infiltrative process can not be excluded, especially given the presence of mediastinal lymph nodes as described below. These segments of myocardium with late gadolinium enhancement are not likely to be viable. The remaining myocardium is without late gadolinium enhancement and likely to be viable. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 166 ml/m2 (normal range: 74+/-15), the LVEDV is ml (normal range 142+/-34), the LV end systolic volume index is 327 ml/m2 (normal range 25+/-9), the LVESV is 166 ml (normal range 47+/-19), the LV mass index is 85 g/m2, and the LV mass is 168 g. The systolic dysfunction is global. . Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is ml (normal range 142+/-31), the RV end systolic volume index is 73 ml/m2 (normal range 31+/-9), and the RVESV is 144 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 (28mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA large mediastinal lymph node is noted. Emphysematous changes noted in lung apices. 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 an area of transmural late gadolinium enhancement noted in the basal inferior and inferolateral walls, most likely consistent with prior myocardial infarction; however, because the late gadolinium enhancement is associated with preserved myocardial wall thickness, the possibility of an infiltrative process can not be excluded, especially given the presence of a mediastinal lymph node. The segments of myocardium with late gadolinium enhancement are not likely to be viable. The remaining myocardium is without late gadolinium enhancement and likely to be viable.3. Severely dilated LV with mildly reduced systolic function (LVEF 45%).4. Mildly dilated RV with moderately reduced systolic function (RVEF 37%).5. Severe left atrial dilation.6. Severe mitral regurgitation.7. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.