46 year old female with newly diagnosed multivessel coronary artery disease after admission for non-ST elevation myocardial infarction. Risk factors included hypertension, hyperlipidemia. She is referred for cardiac MRI for assessment of viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 131 ml/m2 (normal range: 65+/-11), the LVEDV is 254 ml (normal range 109+/-23), the LV end systolic volume index is 95 ml/m2 (normal range 18+/-5), the LVESV is 185 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There is hypokinesis of the basal anterolateral wall, the mid anteroseptum, anterior, anterolateral, and inferolateral walls; and the entire apex. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. No left ventricular thrombus is noted. The pre-contrast native myocardial T1 relaxation times are elevated (~1200 ms) which suggests presence of underlying fibrosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 115 ml (normal range 35+/-13). 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 moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are dilated and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall bilateral pleural effusions are noted. 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 27%).2. The right ventricle is mildly dilated with mildly reduced systolic function (RVEF 41%).3. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. 4. Biatrial enlargement. 5. The SVC and IVC are dilated.6. Moderate tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.