54 year old male with ischemic cardiomyopathy, previous percutaneous coronary intervention of left anterior descending artery and left circumflex referred for cardiac MRI prior to consideration of intervention of right coronary artery chronic total occlusion. Viability/ Myocardial ScarThere was subendocardial (< 50% thickness) late gadolinium enhancement noted of the mid to basal inferior / inferoseptum wall that likely represents prior myocardial infarction and is less likely suggestive of fibrosis, inflammation, or infiltration. The entire myocardium is viable by LGE criteria.Left VentricleThe left ventricle is normal in size and moderately reduced in systolic function . The overall LV ejection fraction is 33%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 145 ml (normal range 47+/-19). There is mild hypokinesis of the mid to basal inferior, inferolateral, and inferoseptal walls and basal inferoseptal and inferior walls. At low dose dobutamine (20 mcg) there is augmented contractility of all segments suggesting viability. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and mildly reduced in systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 139 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is at least mild to moderate 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 IVCdrain 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. There is mild hypokinesis of the mid to basal inferior, inferolateral, and inferoseptal walls and basal inferoseptal and inferior walls. 2. The left ventricle is normal in size and moderately reduced in systolic function (LVEF 33%). 3. The right ventricle is normal in size and mildly reduced in systolic function (RVEF 42%).4. All segments are viable by both LGE and low-dose dobutamine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.