72 year old man with history of ischemic cardiomyopathy and previous PCI, with worsening exertional fatigue, referred for cardiac MRI with vasodilator stress testing.MEDICATIONS: aspirin, atorvastatin, carvedilol, clopidogrel, digoxin, furosemide, hydralazine, spironolactone, valsartan First Pass PerfusionDuring hyperemia, there is no residual ischemia out of regions with myocardial scar.Viability/ Myocardial ScarThere is transmural late gadolinium enhancement involving the mid-apical inferolateral wall and apical inferior wall. This pattern is consistent with transmural myocardial infarction and these segments are not viable. There is also non-transmural infarction involving the mid anterolateral wall. This segment has an intermediate probability of viability. There is another region epicardial late gadolinium enhancement involving the basal inferoseptum, inferior, and inferolateral walls that spares the endocardium and is atypical for myocardial infarction. This suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Viability within these segments can not be determined as the scar is not "ischemic" in nature. The remainder of the myocardium is viable.Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 56 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. There is akinesis of the apical inferior, mid-apical inferolateral walls. There is hypokinesis of the mid anterolateral wall. Left AtriumThe left atrium is mild-moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 85 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 ValveThere is thickening of the anterior mitral leaflet tip. The 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 trace 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 grossly 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. There is no residual "ischemia" noted. 2. The LV is normal in size with moderately reduced systolic function (EF 40%). 3. There is akinesis of the apical inferior and mid-apical inferolateral wall with reduced wall thickness and transmural late gadolinium enhancement. Taken together these findings suggest previous myocardial infarction, with no evidence of viability in these segments. 4. Additionally, there is a non-transmural myocardial infarction involving the mid anterolateral wall. This segment has an intermediate probability of viability. 5. There is a non-myocardial infarction pattern of late gadolinium enhancement involving the base of the left ventricle suggesting that the patient's LV dysfunction is due to both ischemic and non-ischemic etiologies.6. Normal size RV with normal systolic function (EF 50%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.