64 year old man with history of ischemic cardiomyopathy and CAD with recent PCI to LAD and RCA lesions, referred for cardiac MRI to evaluate for viability. Left VentricleThe left ventricle is mild-moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 121 ml/m2 (normal range: 74+/-15), the LVEDV is 244 ml (normal range 142+/-34), the LV end systolic volume index is 70 ml/m2 (normal range 25+/-9), the LVESV is 141 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There is global hypokinesis. There is a midwall stripe in the septum which is atypical for myocardial infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no subendocardial or transmural late gadolinium enhancement to suggest previous myocardial infarction. Native T1 time is borderline elevated (1060ms). Left AtriumThe left atrium is mild-moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 120ml/m2 (normal range 82+/-16), the RVEDV is 243mL (normal range 142+/-31), the RV end systolic volume index is 63ml/m2 (normal range 31+/-9), and the RVESV is 127ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there 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 trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (36mm at the level of bifurcation of the pulmonary artery).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. Mild to moderately dilated left ventricle with moderately reduced systolic function (EF=42%). 2. Mildly dilated right ventricle with mildly reduced systolic function (EF=48%).3. There is late gadolinium enhancement present in a midwall stripe pattern in the septum; this is atypical for previous myocardial infarction and suggests a non-ischemic component to the patient's known cardiomyopathy. 4. At least mild mitral regurgitation. 5. Biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.