67 year old man with recent acute CVA and found to have systolic heart failure and multi-vessel disease. Cardiac MRI done to evaluate for function and viablity Left VentricleThe left ventricle is severely dilated with severe reduced systolic dysfunction. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 173 ml/m2 (normal range: 74+/-15), the LVEDV is 350 ml (normal range 142+/-34), the LV end systolic volume index is 129 ml/m2 (normal range 25+/-9), the LVESV is 262 ml (normal range 47+/-19), the LV mass index is 108 g\m2 (normal range 85+/-15), and the LV mass is 219 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is epicardial late gadolinium enhancement involving the basal anterior wall and them mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. There is no evidence of myocardial infarction and any ischemic segments are likely to be viable. However, because the patient has non-coronary disease related fibrosis, it is unclear whether the LVEF would be expected to improve after revascularization. No LV thrombus is noted. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is upper limits of normal size with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 72ml/m2 (normal range 31+/-9), and the RVESV is 145 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 moderate 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.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 left ventricular dilation and systolic dysfunction (LVEF 25%) due to non-ischemic and ischemic etiologies. There is evidence of myocardial fibrosis in a pattern atypical for myocardial infarction. Normally the absence of myocardial infarction would suggest that the myocardium is viable; however, in this patient, it is unclear whether the LV systolic function would be expected to improve following revascularization due to the presence of non-coronary artery disease related myocardial fibrosis.2. The RV is upper limits of normal size with severely reduced systolic function (RVEF 30%).3. At least moderate mitral regurgitation.4. Severe left atrial dilation.5. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.