76 year old man with recent diagnosis of 2-vessel coronary disease (left circumflex, left anterior descending) and LV dysfunction referred for cardiac MRI to assess viability and function prior to surgery. Left VentricleThe left ventricle is normal in size with moderate-severely reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 106 ml (normal range 31+/-10), the LV mass index is 60 g/m2 (normal range 67+/-11), and the LV mass is 117 g (normal range 114+/-24). There is akinesis of the mid and apical anterior and anteroseptal walls. There is thinning of the affected septal wall segments as well, consistent with previous myocardial infarction. Image quality was limited by respiratory motion, but in some views there appears to be a small apical outpouching with likely element of contractility likely representing a cardiac diverticulum rather than an aneurysm.There is near transmural late gadolinium enhancement in the mid and apical anterior wall, and mid and apical anteroseptum and inferoseptum consistent with nonviable myocardium. The remainder of the myocardium is viable.There is no evidence of LV thrombus.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 59 ml/m2 (normal range 69+/-14), the RVEDV is 115 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant 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. There is mild atherosclerosis of the descending aorta.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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings This 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. Normal size left ventricle with moderate-severely reduced systolic function (EF 37%).2. There are multiple regional wall motion abnormalities in the distribution of the left anterior descending artery with associated wall thinning (mid-distal anterior wall and anteroseptum). There is transmural late gadolinium enhancement in these segments consistent with established nonviable myocardium due to previous myocardial infarction.3. The remainder of the myocardium is viable. 4. On limited views, there is a possible small apical diverticulum noted. 5. No evidence of LV thrombus. 6. Normal size right ventricle with mildly reduced systolic function.7. Atherosclerosis of the descending aorta.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.