61 year old man with history of 5V CABG in 2011. He had a recent VT arrest. Subsequent angiogram with patent grafts. Patient referred to assess for myocardial fibrosis, etc. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. There is hypokinesis of the basal inferolateral and anterolateral walls, severe hypokinesis of the mid inferior and inferolateral walls, there is hypokinesis of the apical inferior wall. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 171 ml/m2 (normal range: 74+/-15), the LVEDV is 338 ml (normal range 142+/-34), the LV end systolic volume index is 115 ml/m2 (normal range 25+/-9), the LVESV is 227 ml (normal range 47+/-19), the LV mass index is 96 g/m2 (normal range 85+/-15), and the LV mass is 189 g (normal range 164+/-36). There is a predominantly transmural myocardial infarction associated with almost all of the above dysfunctional segments. The majority of this region is non-viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. No LV thrombus is noted. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 164 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).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 mildly dilated (SOV 43mm).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 LV is severely dilated with moderately reduced systolic function (LVEF 33%). There is a large wall motion abnormality with a transmural myocardial infarction as described above. The dysfunctional segments are predominantly non-viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.2. Normal RV size and systolic function (RVEF 61%).3. Moderate left atrial dilation.4. The aortic root is mildly dilated. When the echocardiogram from 3/23/2015 was re-reviewed, it is evident that the LV ejection fraction was previously significantly over-estimated due to poor visualization of the endocardial border due to technically limited images. There has probably been no significant change in ejection fraction from the prior echo to today's MRI.