75 year old woman with history of LV dysfunction who presents for stress cardiac MRI to evaluate for coronary disease as etiology of cardiomyopathyMEDICATIONS: hydralazine, isosorbide dinitrate, lisinopril, zocor First Pass PerfusionDuring hyperemia, there is a perfusion defect noted in the mid-inferior/inferolateral wallViability/ Myocardial ScarThere is late gadolinium enhancement transmural in thickness in the mid-inferolateral wall. This region is likely not viable. The remainder of the myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 114 ml/m2 (normal range: 65+/-11), the LVEDV is 208 ml (normal range 109+/-23), the LV end systolic volume index is 89 ml/m2 (normal range 18+/-5), the LVESV is 164 ml (normal range 31+/-10), the LV mass index is 64 g/m2, and the LV mass is 117 g. There is diffuse hypokinesis. Mid-distal inferior and inferolateral akinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 147 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 96 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there at least mild mitral regurgitation difficult to quantify on this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 mildly dilatated. Venous AnatomyThe IVC is dilated.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 severely dilated with severely reduced systolic function (LVEF 21%). Mid-distal inferior and inferolateral akinesis. 2. There is a perfusion defect noted in the mid-inferior/ inferolateral wall3. There is late gadolinium enhancement transmural in thickness in the mid-inferolateral wall. This region is likely not viable. The remainder of the myocardium is viable. 4. The right ventricle is normal in size with moderately reduced systolic function (RVEF 35%).