64 year old male with extensive CAD (3v CABG 2015, VF arrest/STEMI with PCI to SVG-RCA 11/2015), HTN, hyperlipidemia presenting for evaluation of viability and ischemia prior to possible revascularization. MEDICATIONS: atorvastatin, aspirin, carvedilol, amiodarone, lisinopril, ticagrelolor First Pass PerfusionDuring hyperemia, perfusion defects were present in the mid inferolateral and basal infero-septal, inferior, inferolateral and lateral walls. Viability/ Myocardial ScarThere was late gadolinium enhancement noted in the apical-mid inferior wall (<50%), and mid to basal lateral and inferolateral walls (approximately 50%) subendocardial late gadolinium enhancement in a pattern typical for myocardial infarction; there is a focal area of delayed hyperenhancement within the mid inferolateral wall which is transmural, best seen on 3 chamber images. The areas with 50% wall thickness LGE are unlikely to be viable and the area of <50% is of intermediate likelihood of being viable. The remaining myocardium is likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 110 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 109 g. There is hypokinesis present in the basal inferior and inferolateral walls. . Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 106 ml (normal range 142+/-31), the RV end systolic volume index is 17 ml/m2 (normal range 31+/-9), and the RVESV is 32 ml (normal range 54+/-17).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 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 FindingsNonacute right anterior rib fractures, likely from previous CPR. 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. Perfusion defects were present in the mid inferolateral and basal infero-septal, inferior, inferolateral and lateral walls.2. Late gadolinium enhancement noted in the apical-mid inferior wall (<50%), and mid to basal lateral and inferolateral walls (approximately 50%) subendocardial late gadolinium enhancement in a pattern typical for myocardial infarction; there is a focal area of delayed hyperenhancement within the mid inferolateral wall which is transmural, best seen on 3 chamber images. The areas with 50% wall thickness LGE are unlikely to be viable and the area of <50% is of intermediate likelihood of being viable. The remaining myocardium is likely to be viable. 3. Normal LV size and systolic function (LVEF 65%). There is hypokinesis present in the basal inferior and inferolateral walls. 4. Normal RV size and systolic function (RVEF 69%).