A 61 year old male with personal history of hypertension, hyperlipidemia and ischemic cardiomyopathy who is now hospitalized with heart failure symptoms and multiple vessel disease on angiography. Referred to cardiac MRI to assess viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 177 ml/m2 (normal range: 74+/-15), the LVEDV is 388 ml (normal range 142+/-34), the LV end systolic volume index is 152 ml/m2 (normal range 25+/-9), the LVESV is 335 ml (normal range 47+/-19), the LV mass index is 119 g/m2 (normal range 85+/-15), and the LV mass is 261 g (normal range 164+/-36). There severe global hypokinesis with regional variation.There is basal aneurysm of the inferior-inferoseptal wall. There is an apical aneurysm. There are several areas with late gadolinium enhancement: the apical cap, the basal-mid inferior-inferoseptum (non-transmural), the proximal part of the base-apical anterior and anteroseptal walls (non-transmural at the proximal aspect of the base and mid segments, transmural at the apex). These findings represent fibrosis secondary to old myocardial infarction (s). The anterior and anteroseptal walls have intermediate to no viability. The apex is not viable. The remainder of the myocardium appears viable. There is moderate hypertrophy of the non-infarcted myocardium (up to 16mm at the basal anteroseptum). No intracavitary thrombus was seen.Left AtriumThe left atrium is severely dilated (216ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 185 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 106 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant 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 sinus of valsalva measures 44 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.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 severely dilated with severely reduced systolic function, the LVEF is 14%. There severe global hypokinesis with regional variation.There is basal aneurysm of the inferior-inferoseptal wall. There is an apical aneurysm.2. There are several areas with late gadolinium enhancement: the apical cap, the basal-mid inferior-inferoseptum (non-transmural), the proximal part of the base-apical anterior and anteroseptal wall (non-transmural at the proximal aspect of the base and mid segments, transmural at the apex). These findings represent fibrosis secondary to old myocardial infarction (s). The anterior and anteroseptal walls have intermediate viability. The apex is not viable. The remainder of the myocardium appears viable. There is moderate hypertrophy of the non-infarcted myocardium (up to 16mm at the basal anteroseptum). 3. No intracavitary thrombus was seen.4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 43%. 5. The left and right atrium are severely dilated. 6. The sinus of valsalva measures 44 mm.8. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.