78 year old male with a history of coronary artery disease, pulmonary embolism, with recent ventricular fibrillation arrest (Torsades de Pointes). He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with moderately reduced ejection fraction. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 301 ml (normal range 142+/-34), the LV end systolic volume index is 90 ml/m2 (normal range 25+/-9), the LVESV is 205 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 105 g (normal range 164+/-36). There is hypokinesis of most of the inferior wall and the basal inferoseptum. There is late gadolinium enhancement of the basal inferoseptum and basal to mid inferior wall, consistent with prior myocardial infarction. This territory is not likely to be viable. The remainder of the myocardium is free of late gadolinium enhancement and is viable. The global pre-contrast myocardial T1 relaxation times is normal (1042 ms). Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 77 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 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 moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral lower lung infiltrates vs atelectasis vs infarct. Small left pleural effusion. 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 moderately dilated with moderately reduced systolic function (LVEF 32%).2. The right ventricle is normal in size and systolic function (RVEF 61%).3. There is an old, transmural myocardial infarction involving the basal inferoseptum and the basal to mid inferior wall. This territory is not likely to be viable. 4. Main pulmonary artery is moderately dilated.5. See extra-cardiac findings. 