49 year old man with NICM and VT, referred for evaluation of underlying scar. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 152 ml/m2 (normal range: 74+/-15), the LVEDV is 324 ml (normal range 142+/-34), the LV end systolic volume index is 106 ml/m2 (normal range 25+/-9), the LVESV is 226 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 135 g (normal range 164+/-36). LV dysfunction is global. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum. There is also epicardial late gadolinium enhancement of the basal inferior and inferolateral walls. These findings are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Much of the anterior and anterolateral wall is not well seen due to artifact from the ICD.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Extracardiac FindingsThis 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. Severe LV dilation with severely reduced systolic function (LVEF 30%). 2. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum. There is also epicardial late gadolinium enhancement of the basal inferior and inferolateral walls. These findings are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Much of the anterior and anterolateral wall is not well seen due to artifact from the ICD. This pattern of late gadolinium enhancement has been described in dilated cardiomyopathy and also old myocarditis. 3. Normal RV size and systolic function (RVEF 57%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.