46 year old male with heart failure with reduced ejection fraction on Milrinone, history of alcohol abuse referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 230 ml/m2 (normal range: 74+/-15), the LVEDV is 573 ml (normal range 142+/-34), the LV end systolic volume index is 192 ml/m2 (normal range 25+/-9), the LVESV is 479 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 162 g (normal range 164+/-36). The is global hypokinesis with regional variation. The apical to mid inferolateral wall is akinetic and thinned. There is predominantly transmural late gadolinium enhancement of the mid inferolateral wall that is consistent with prior myocardial infarction and the territory is not likely to be viable. There is additionally a mid-wall stripe of late gadolinium enhancement of the basal septum suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Together, these findings suggest both an ischemic and non-ischemic etiology of the cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced ejection fraction . The overall RV ejection fraction is 19%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 291 ml (normal range 142+/-31), the RV end systolic volume index is 95 ml/m2 (normal range 31+/-9), and the RVESV is 237 ml (normal range 54+/-17).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 at least moderate 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 root is normal in size.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 a small 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 17%). There is evidence of (1) a predominantly transmural myocardial infarction involving the basal to mid inferior and inferolateral walls and (2) a mid-wall stripe of fibrosis involving the basal interventricular septum. Together, these findings suggest a dual (ischemic and non-ischemic) etiology of the cardiomyopathy. 2. The right ventricle is mildly dilated with severely reduced ejection fraction (RVEF 19%)3. The territory affected by the myocardium is not likely to be viable. 4. There is at least moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.