37 year old with history of prior myocardial infarction is referred to evaluate LV function and viability. 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 127 ml/m2 (normal range: 65+/-11), the LVEDV is 294 ml (normal range 109+/-23), the LV end systolic volume index is 85 ml/m2 (normal range 18+/-5), the LVESV is 197 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 147 g (normal range 114+/-24). The LV dysfunction is global with regional variation, specifically the mid to basal inferior, inferoseptum, and septal walls appear hypokinetic . There is mid-wall stripe pattern of myocardial late gadolinium enhancement in the septal wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is more typical of nonischemic cardiomyopathy such as dilated cardiomyopathy or old myocarditis rather than ischemic cardiomyopathy. Left AtriumThe left atrium is severely enlarged.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). 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 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 obvious pericardial disease. There is a small pericardial effusion. Extracardiac FindingsThe thyroid gland is somewhat enlarged. 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. The left ventricle is severely enlarged with moderately reduced systolic function. The overall LV ejection fraction is 33%. There is evidence of a mid-wall stripe of septal late gadolinium enhancement. The pattern is not typical for prior myocardial infarction. It is well described to represent myocardial fibrosis in patients with dilated cardiomyopathy or old myocarditis.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%3. Severe left atrial dilation.4. Small pericardial effusion.5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.