77 year-old man with a history of hypertension, coronary artery disease, ischemic cardiomyopathy and recurrent VT with ICD, now presenting for pre-ablation cardiac MRI to evaluate for scar. There is significant artifact related to the patient's indwelling ICD, but the image quality is diagnostic allowing for the following observations to be made:Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function . The overall LV ejection fraction is 35%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 242 ml (normal range 142+/-34), the LV end systolic volume index is 85 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19). There is akinesis of the mid-distal inferolateral, inferior and inferoseptal wall. There is apical dyskinesis. There is subendocardial late gadolinium enhancement in the mid anteroseptum/anterior wall which involves >50% of the wall thickness, and may be consistent with prior myocardial infarction. Left AtriumThe left atrium is enlarged. Right VentricleRV volumes could not be reliably measured due to artifact. Visually the ventricle appears mildly dilated with normal systolic function. There is a defibrillator lead, the tip of which terminates in the distal right ventricle.Right AtriumThe right atrium is enlarged; there is a device lead present.Aortic ValveThe aortic valve opens widely and there is trivial significant aortic regurgitation.Mitral ValveThe mitral valve opens widely with mild thickening of the leaflet tips. 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. The aortic root is grossly normal in size. The descending aorta is moderately tortuous.Pulmonary VeinsThere appear to be four pulmonary veins which drain into the left atrium.Pulmonary ArteryThe main pulmonary artery is not well visualized.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable exophytic left renal cyst is noted. 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. Severely dilated left ventricle with moderately reduced ejection fraction of 35%. There is evidence of apical thinning and dyskinesis.2. There is subendocardial late gadolinium enhancement in the mid anteroseptum/anterior wall which involves >50% of the wall thickness, consistent with prior myocardial infarction. 