A 48 years old female with non-ischemic cardiomyopathy, moderate to severe left ventricular and mild right ventricular systolic dysfunction. Referred to MRI to evaluate ischemia and etiology.MEDICATIONS: Aspirin, Carvedilol, Glipizide, Lisinopril, metformin, Simvastatin First Pass PerfusionDuring hyperemia, there is a mild perfusion defect involving the apical septum and the mid inferior and inferoseptal walls. There is additionally a prominent dark rim artifact making image interpretation difficult.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is severely dilated with moderate to severe systolic dysfunction. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 105 ml/m2 (normal range: 65+/-11), the LVEDV is 207 ml (normal range 109+/-23), the LV end systolic volume index is 72 ml/m2 (normal range 18+/-5), the LVESV is 142 ml (normal range 31+/-10), the LV mass index is 56 g/m2, and the LV mass is 111 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mild systolic dysfunction. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe 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 mild 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trace 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. There is mild ischemia in the usual distribution of the right coronary artery.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is severely dilated with moderate to severe systolic dysfunction (LVEF 31%).4. The right ventricle is normal in size with mild systolic dysfunction (RVEF 46%). 5. Left atrium is moderately dilated.6. Mild tricuspid and mitral regurgitation.