51 year old man with history of inferior STEMI s/p PCI to RCA and LAD chronic total occlusion, referred for CMR for evaluation of LV function and underlying scar. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 260 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 162 ml (normal range 47+/-19), the LV mass index is 71 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). There is hypokinesis of the basal inferior/inferolateral walls and akinesis with associated myocardial thinning of the mid through apical inferior/inferolateral walls. There is apical akinesis. There is late gadolinium enhancement that is transmural in the apex and the mid through apical inferior/inferolateral walls. This is consistent with transmural infarction and this area is not likely to be viable. There is another area of subendocardial late gadolinium enhancement of the basal inferior/inferolateral walls and the mid anterior/anteroseptal walls. These areas are consistent with prior myocardial infarction and occupy about 50% of the myocardium thickness, indicating an intermediate probability of viability. The remainder of the myocardium appears viable. There is no LV thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 obvious pericardial disease.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. The left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%.2. There is hypo/akinesis of the inferior/inferolateral walls with apical akinesis. 3. There is transmural late gadolinium enhancement in the inferior/inferolateral walls and apex that is consistent with prior myocardial infarction. This area is not likely to be viable. There is another area of subendocardial late gadolinium enhancement of the basal inferior/inferolateral walls and the mid anterior/anteroseptal walls that have an intermediate probability of viability. The remainder of the myocardium appears viable.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.