68 year old with history of ischemic cardiomyopathy with biventricular pacing/ICD presenting for cardiac evaluation as part of workup for advanced options. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 175 ml/m2 (normal range: 74+/-15), the LVEDV is 320 ml (normal range 142+/-34), the LV end systolic volume index is 124 ml/m2 (normal range 25+/-9), the LVESV is 228 ml (normal range 47+/-19), the LV mass index is 110 g/m2 (normal range 85+/-15), and the LV mass is 201 g (normal range 164+/-36). There is global hypokinesis with additional akinesis in the mid to basal inferior and inferolateral wall. There is correlating transmural (>50%) late gadolinium enhancement mid to basal inferolateral wall in a pattern consistent with myocardial infarction. 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 33%, the RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 137 ml (normal range 54+/-17).Right AtriumThe right atrium is grossly normal in size.Aortic ValveThe aortic valve opens widely and there is trace significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation. The degree of regurgitation is difficult to quantify due to the artifact. Pulmonic ValveNot well seen. Tricuspid ValveNot well seen. AortaNot well seen.Pulmonary VeinsNot well seen. Pulmonary ArteryNot well seen. Venous AnatomyNot well seen. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge bilateral pleural effusions. 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 dilated with severely reduced systolic function. The overall LV ejection fraction is 29%. There akinesis in the mid to basal inferior and inferolateral wall. There is correlating transmural (>50%) late gadolinium enhancement mid to basal inferolateral wall in a pattern consistent with myocardial infarction. No MRI evidence to support the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%. 3. Severe left atrial enlargement. 4. At least moderate mitral regurgitation. 5. Marked bilateral pleural effusion. 