65 year old with ischemic cardiomyopathy presenting for evaluation of left ventricular function and scar prior to possible ICD implant. Left VentricleThe left ventricle is severely dilated. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 110 ml/m2 (normal range 25+/-9), the LVESV is 243 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 135 g (normal range 164+/-36). There is extensive enhancement reflecting myocardial infarct as result of three-vessel coronary artery disease. The most extensive enhancement is noted in the anterior and septal walls. There is subendocardial enhancement (less than 50% wall thickness) of the basal septum. At the mid chamber, there is transmural enhancement of the anterior septum with subendocardial (less than 50% wall thickness) enhancement of the inferoseptum. At the apex, the enhancement is transmural.The basal anterior wall is free from enhancement. There is transmural enhancement at the mid chamber, extending to the apex. There is subendocardial enhancement extending from the base to the mid chamber, sparing the apex.The apical two thirds of the inferior wall demonstrate transmural enhancement.No intracardiac thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal size. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 193 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 116 ml (normal range 54+/-17). No enhancement is identified.Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mitral regurgitation which was not quantified on this examination but by visual inspection appears to be at least moderate. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.
1. Extensive myocardial enhancement of the left ventricle reflective of myocardial infarct from from three-vessel coronary artery disease. No intracardiac thrombus.2. The left ventricle is moderately dilated with reduced systolic function. The left ventricular ejection fraction equals 26%.3. Moderate dilatation of the left atrium with mitral regurgitation, estimated to be at least moderate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.