A 56 year old female with history of ischemic cardiomyopathy, s/p myocardial infarction in 2004 with PCI to LAD, perfusion defects in the LAd, LCx and RCA territories in a recent stress nuclear study. A recent echocardiography showed LVEF of 45-50%. Referred to cardiac MRI to assess viability. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 160 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 99 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). There is akinesis and thinning of the mid-to-apical segments of the anterior, anteroseptal walls. There is apical aneurysm. Mild tardokinesis is noted of the inferolateral wall. There is transmural late gadolinium enhancement at the entire apex, and up to 50% of the thickness of the mid-distal anterior and anteroseptal walls. A small area of subendocardial late gadolinium enhancement is also noted in the the mid inferoseptum. These findings represent fibrosis secondary to old myocardial infarction. The burden of fibrosis is 31% of the total myocardium. These segments are not viable but the remainder of the myocardium is viable. No intracavitary thrombus was seen.Left AtriumThe left atrium is normal in size. The LA volume is 74 ml.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 45 ml/m2 (normal range 69+/-14), the RVEDV is 91 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 42 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 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 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 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 normal in size with moderately reduced systolic function, the LVEF is 38%. There is akinesis and thinning of the mid-to-apical segments of the anterior, anteroseptal walls. There is apical aneurysm. Mild tardokinesis is noted of the inferolateral wall. There is apical aneurysm. No intracavitary thrombus was seen.2.There is transmural late gadolinium enhancement at the entire apex, and up to 50% of the thickness of the mid-distal anterior and anteroseptal walls. A small area of subendocardial late gadolinium enhancement is also noted in the the mid inferoseptum. These findings represent fibrosis secondary to old myocardial infarction. The burden of fibrosis is 31% of the total myocardium. These segments are not viable but the remainder of the myocardium is viable. 3. The right ventricle is normal in size and systolic function, the RVEF is 54%.