34 year old man with history of type 2 diabetes, hypertension and known LV dysfunction, as well as coronary angiography with RCA and LAD disease, who presents for cardiac MRI with vasodilator stress testing and contrast to evaluate for ischemic burden and viability. First Pass PerfusionDuring hyperemia, perfusion defects involved the entire ventricle except the basal to mid lateral wall. Viability/ Myocardial ScarThere was a small transmural myocardial infarction involving the apical inferior and septal walls. These territories are not viable. The remainder of the myocardium is free of myocardial infarction and is highly likely to be viable. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 153 ml/m2 (normal range: 74+/-15), the LVEDV is 380 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 255 ml (normal range 47+/-19), the LV mass index is 92 g/m2, and the LV mass is 228 g. There is global hypokinesis with regional variationLeft AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 225 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 102 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. A trivial pericardial effusion is present.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. Extensive ischemia involving nearly the entire left ventricle except the basal to mid lateral wall.2. There was a small transmural myocardial infarction involving the apical inferior and septal walls. These territories are not viable. The remainder of the myocardium is free of myocardial infarction and is highly likely to be viable. 3. Severe LV dilation with moderately reduced systolic function (LVEF 33%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.