73 year man with coronary artery disease, ischemic cardiomyopathy, paroxysmal atrial fibrillation, DM, CK, pulmonary sarcoidosis, and ventricular tachycardia. Resting SPECT perfusion defects noted in the mid to apical inferior wall, the apical septum and anterior walls, and in the apical cap. LVEF (visual) on TTE was 35%. Referred for cardiac MRI to delineate scar tissue for possible ablation. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%. Evaluation of systolic function is slightly limited by imaging artifact from the AICD. The LVEDV is 285 ml (normal range 142+/-34), the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVESV is 77 ml (normal range 47+/-19) and the LV end systolic volume index is 104 ml/m2 (normal range 25+/-9). The LV mass is 132 g (normal range 164+/-36) and the LV mass index is 65 g/m2 (normal range 85+/-15). There is akinesis and severe thinning of the apical cap and apical septum extending into the apical anterior and inferior walls. There is hypokinesis and moderate thinning of the mid septum as well as basal lateral LV wall. There is question mild septal dyskinesis suggestive of intra-ventricular conduction delay. There are multiple areas of full thickness and near full-thickness (75%) late gadolinium enhancement in the mid and apical septum, in the apical anterior and inferior walls and apical cap. There is also full thickness late gadolinium enhancement in the entire basal septum.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 38%. The RVEDV is 149 ml (normal range 142+/-31), RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVESV is 92 ml (normal range 54+/-17), and the RV end systolic volume index is 46 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 no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation which may be related to ICD lead. ICD lead is noted in the right ventricle.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 FindingsMutiple enlarged lymph nodes in the mediastinum and bilateral hila compatible with patient's history of sarcoidosis. Right upper lung irregular opacity likely scarring, but incompletely evaluated on this study.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.The left ventricle is moderately dilated with severely reduced systolic function. LVEF 27%. Evaluation of systolic function is slightly limited by imaging artifact from the AICD.2.The right ventricle is normal in size with moderately reduced systolic function. RVEF 38%.3.Three vessel coronary artery disease with nonviable myocardium involving predominantly the mid and apical septum and basal lateral wall as detailed above.4.Stigmata of sarcoidosis with likely bandlike scarring in the right upper lobe.