57 year old man with history of CAD s/p multiple PCI, referred for stress CMR for evaluation of chest pain.MEDICATIONS: amlodipine, ASA, plavix, zetia, simvastatin, irbesartan, imdur, atenolol. First Pass PerfusionDuring hyperemia, there is a perfusion defect along the inferolateral wall extending from base to apex.Viability/ Myocardial ScarThere was is a subendocardial, non-transmural myocardial infarction/ late gadolinium enhancement involving the basal to mid inferolateral wall. This territory has intermediate viability. There is additionally a second very small transmural myocardial infarction involving the apical lateral wall. This small territory is not viable. The remainder of myocardium is free of myocardial infarction and 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 96 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 42 g/m2, and the LV mass is 95 g. There is mild hypokinesis of the mid inferolateral wall. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 203 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 68 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 FindingsThis 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, there is a perfusion defect/ "ischemia" along the inferolateral wall extending from base to apex.2. There was is a subendocardial, non-transmural myocardial infarction involving the basal to mid inferolateral wall. This territory has intermediate viability. There is additionally a second very small transmural myocardial infarction involving the apical lateral wall. This small territory is not viable. The remainder of myocardium is free of myocardial infarction and likely to be viable.3. Normal LV size and systolic function (LVEF 65%) with mild hypokinesis of the mid inferolateral wall.4. Normal RV size and systolic function (RVEF 66%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.