A 51 year old male with personal history of coronary artery disease and diabetes mellitus, now hospitalized with acute on chronic heart failure while the echocardiography showed a severely reduced systolic function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 147 ml/m2 (normal range: 74+/-15), the LVEDV is 327 ml (normal range 142+/-34), the LV end systolic volume index is 127 ml/m2 (normal range 25+/-9), the LVESV is 283 ml (normal range 47+/-19), the LV mass index is 76 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). The base to mid segments of the lateral, inferolateral and inferior walls are hypokinetic, the other segments are akinetic. There is intermediate signal of late gadolinium enhancement at the mid-myocardium, which may be artifactual. No convincing evidence of an infiltrative or fibrotic process. No evidence of infarct on delayed hyperenhancement MRI. No myocardial iron overload.The native myocardial T1-times are normal.No intracavitary thrombus was seen.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 144 ml/m2 (normal range 82+/-16), the RVEDV is 321 ml (normal range 142+/-31), the RV end systolic volume index is 104 ml/m2 (normal range 31+/-9), and the RVESV is 231 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate 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 drain normally into the right atrium.PericardiumThere is trace pericardial effusion.Extracardiac FindingsA moderate right pleural effusion was seen. 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 LVEF is 14%. The base to mid segments of the lateral, inferolateral and inferior walls are hypokinetic, the other segments are akinetic. 2. No convincing evidence of myocardial infarction. No evidence of an infiltrative or fibrotic process within the LV myocardium.3. The right ventricle is moderately dilated with severely reduced systolic function, the RVEF is 28%. 4. There is bilateral atrium dilation.5. At least mild MR and moderate TR.6. Moderate right pleural effusion.