43Yrs old with a history of recurrent VTE/PE, central retinal vein occlusion in 7/2016, significant EtOH use (1 pint a day) and recently diagnosed severe LV dysfunction with EF 20% - who was referred for cardiac MRI to help ascertain the etiology of his cardiomyopathy. MEDICATIONS: aspirin, carvedilol, lisinopril, metoprolol, warfarin First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderately dilated with moderately depressed systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 261 ml (normal range 142+/-34), the LV end systolic volume index is 81 ml/m2 (normal range 25+/-9), the LVESV is 166 ml (normal range 47+/-19), the LV mass index is 86 g/m2, and the LV mass is 176 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly depressed systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 118 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 ValveThere 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 normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial disease.Extracardiac FindingsFocal areas of abnormal signal intensity in the right lower lobe represent scarring after prior pulmonary infarction.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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction or abnormal late gadolinium enhancement to suggest infiltrative, fibrotic or inflammatory disease. The entire myocardium is viable.3. Moderately dilated LV with moderately depressed systolic function. LVEF 37%4. Normal sized RV with mildly depressed systolic function. RVEF 43%