63 year old male with multivessel CAD on LHC. Referred for MRI for viability assessment prior to CABG. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%. The LVEDV is 245 ml (normal range 142+/-34), the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVESV is 160 ml (normal range 47+/-19) and the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9). There is thinning and significant hypokinesis of the anterior and anteroseptal wall from the mid left ventricle to the apex and the distal anterolateral wall. The entire apex is akinetic. These same areas also have subendocardial and mid myocardial delayed gadolinium enhancement, consistent with a previous transmural myocardial infarction in the left coronary artery (LAD) territory. There appears to be viability in the mid-distal anterior, distal lateral walls. The entire apex and mid-distal anteroseptum are non-viable. The apical myocardium is akinetic and appears non viable. The native T1 myocardial relaxation time is within normal limits suggestive the absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 49%. The RVEDV is 160 ml (normal range 142+/-31), RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVESV is 81 ml (normal range 54+/-17), and the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild 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.AortaThere is a left sided aortic arch. The aortic root is normal in size.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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is increase pulmonary vascularity in bilateral lung bases posteriorly. 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 moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%. 2. There is thinning and significant hypokinesis of the anterior and anteroseptal wall from the mid left ventricle to the apex and the distal anterolateral wall. The entire apex is akinetic. These same areas also have subendocardial and mid myocardial delayed gadolinium enhancement, consistent with a previous transmural myocardial infarction in the left coronary artery (LAD) territory. There appears to be viability in the mid-distal anterior, distal lateral walls. The entire apex and mid-distal anteroseptum are non-viable. The apical myocardium is akinetic and appears non viable. .3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 49%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.