64 year old male physician with remote history of coronary disease, recently presenting with severe LV dysfunction and found to have multivessel coronary disease with plans for CABG. He is referred for cardiac MR to evaluate viability. Left VentricleThe left ventricle is moderate-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: 74+/-15), the LVEDV is 250 ml (normal range 142+/-34), the LV end systolic volume index is 95 ml/m2 (normal range 25+/-9), the LVESV is 182 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There is no evidence for myocardial iron overload. There is hypokinesis of the apical inferior and inferolateral wall. The basal and mid inferior and inferolateral walls are thinned and akinetic. There is a stripe of late enhancement in the basal-mid septum and basal inferoseptum. There is prominent late gadolinium enhancement which is transmural and involves the basal to mid inferolateral wall, which suggests a previous infarction in this territory with no viability. There is subendocardial late gadolinium enhancement in the basal to mid inferior wall which encompasses <50% of the myocardium and suggests intermediate probability of viability. The remaining myocardium is viable. Left AtriumThe left atrium is moderately dilated. There is lipomatous hypertrophy of the interatrial septum.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 44 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 ValveThe posterior mitral leaflet appears tethered. There is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a "bovine" brachiocephalic branching pattern. The aortic root is normal in size. The descending aorta has mild-moderate diffuse atherosclerosis.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 a trivial pericardial effusion.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. Moderate-severely dilated left ventricle with severely reduced EF (LVEF 27%). 2. There is thinning of the basal and mid inferior and inferolateral walls with associated akinesis. Associated hypointensity suggests associated calcified regions which would indicate that this is likely chronic infarct.3. There is transmural late gadolinium enhancement in the basal and mid inferolateral wall, involving the entirety of the myocardium, suggesting no viability in this territory. There is another region of late gadolinium enhancement which is subendocardial involving <50% of the basal and mid inferior wall, which suggests an intermediate probability of viability in this territory. This is consistent with ischemic cardiomyopathy.4. There is a stripe of late gadolinium enhancement seen in the basal septum, which is likely artifactual in nature.4. Normal size right ventricle with mildly reduced systolic function (RVEF 47%).5. Posterior mitral leaflet tethering with at least mild MR.6. Atherosclerosis of the descending aorta. 