46 year old woman with history of heart failure, CVA referred for CMRI for further evaluation of cardiac function and viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 12%, the LV end diastolic volume index is 235 ml/m2 (normal range: 65+/-11), the LVEDV is 415 ml (normal range 109+/-23), the LV end systolic volume index is 206 ml/m2 (normal range 18+/-5), the LVESV is 364 ml (normal range 31+/-10), the LV mass index is 86 g/m2 (normal range 67+/-11), and the LV mass is 152 g (normal range 114+/-24). There is akinesis of the apical two thirds of the anterior wall, apical one half of the inferior wall, apical one half of the lateral wall and apical two thirds of the septum. The segments are thinned. The remaining basal segments are severely hypokinetic. Limited post contrast assessment was obtained on this study, which limits full viability evaluation; however, overall appearance is of a proximal wrap-around LAD infarct that is considered to likely be nonviable due to the degree of thinning. There is no LV thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mild to moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 135 ml/m2 (normal range 69+/-14), the RVEDV is 197 ml (normal range 110+/-24), the RV end systolic volume index is 111 ml/m2 (normal range 22+/-8), and the RVESV is 197 ml (normal range 35+/-13). Right AtriumThe right atrium is mild to moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is MR in the setting of LV dilation with at least moderate, if not severe MR. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is estimated mild 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a large left pleural effusion with compression of the entire left lung and rightward shift of the mediastinum. The pleural effusion is increased since prior CT thorax. The previous right pleural effusion is resolved. There are small axillary lymph nodes which may be reactive in nature.
1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 12%. There is akinesis of the basal, mid and apical anterior, septal and infero-septal walls. The myocardium is thinned and dilated. Limited post contrast assessment was obtained on this study which limits full viability evaluation, however overall appearance is of a proximal wrap-around LAD infarct that is less likely to be viable. 2. There is no evidence of an LV thrombus.3. The right ventricle is mild to moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 17%4. Large left pleural effusion, as described above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.