68 year old man with a past medical history of HFrEF (LVEF=22%), CVA x3, DVT, HTN presenting with SOB. Referred for cardiac MRI to assess myocardial viability Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 23%. The LVEDV is 258 ml (normal range 142+/-34), the LV end diastolic volume index is 153 ml/m2 (normal range: 74+/-15), the LVESV is 198 ml (normal range 47+/-19) and the LV end systolic volume index is 117 ml/m2 (normal range 25+/-9). The LV mass is 177 g (normal range 164+/-36) and the LV mass index is 105 g/m2 (normal range 85+/-15). There is global left ventricular systolic dysfunction with regional variation. The basal septum is hypertrophied (20mm). There is akinesis of the inferior, inferolateral and lateral walls. There is a basal inferolateral aneurysm with apical dyskinesis. - There is transmural (>50%) late gadolinium enhancement in the basal to mid inferolateral and lateral walls. This area is not viable. - There is subendocardial late gadolinium enhancement in the mid-apical antero-septum. This region is of intermediate viability.- There is transmural late gadolinium enhancement at the apical cap (>50%). This area is not viable. - The remainder of the myocardium is viable.Left AtriumThe left atrium is not well visualized. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%. The RVEDV is 103 ml (normal range 142+/-31), RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVESV is 40 ml (normal range 54+/-17), and the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is moderate central aortic regurgitation (regurgitant fraction 32%).Mitral ValveThe mitral valve opens widely and there is at least 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. The ascending aorta is mildly dilated (41x42 mm). The descending aorta makes a sharp turn from the left to the midline at the level of T6-7.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 moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 23%2.There is global left ventricular systolic dysfunction with regional variation. There is akinesis of the inferior, inferolateral and lateral walls. There is a basal inferolateral aneurysm with apical dyskinesis. 3. There is transmural (>50%) late gadolinium enhancement in the basal to mid inferolateral and lateral walls. This area is not viable. There is subendocardial late gadolinium enhancement in the mid-apical antero-septum. This region is of intermediate viability. There is transmural late gadolinium enhancement at the apical cap (>50%). This area is not viable. The remainder of the myocardium is viable. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%5. Moderate central aortic insufficiency (regurgitant fraction 32%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.