64 year old male with COPD, presented with shortness of breath, HFrEF, triple vessel disease and LV thrombus. Referred for MRI evaluation prior to possible CABG. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 14%. The LVEDV is 243 ml (normal range 142+/-34), the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVESV is 209 ml (normal range 47+/-19) and the LV end systolic volume index is 121 ml/m2 (normal range 25+/-9). The LV mass is 111 g (normal range 164+/-36) and the LV mass index is 64 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is transmural late gadolinium enhancement involving the entire apex, mid-apical inferior and inferoseptal walls. This area is non-viable. There is subendocardial late gadolinium enhancement involving >50% of the anteroseptal and anterior walls. These territories are of intermediate viability. The remaining myocardium is viable. The pattern on late gadolinium enhancement is consistent with prior myocardial infarction.There is no myocardial iron overload. There is a small thrombus noted in the LV apex. Left AtriumThe left atrium is moderately dilated. There is no obvious LAA thrombus noted.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 30%. The RVEDV is 177 ml (normal range 142+/-31), RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVESV is 125 ml (normal range 54+/-17), and the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 at least mild 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a mild-moderate sized right and a trivial 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 severely reduced systolic function. The overall LV ejection fraction is 14%. 2.The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 30%.3.There is transmural late gadolinium enhancement involving the entire apex, mid-apical inferior and inferoseptal walls. This area is non-viable. There is subendocardial late gadolinium enhancement involving >50% of the anteroseptal and anterior walls. These territories are of intermediate viability. The remaining myocardium is viable. The pattern on late gadolinium enhancement is consistent with prior myocardial infarction.4.There is a small apical LV thrombus noted.5.There is at least moderate mitral regurgitation.6.There is at least mild tricuspid regurgitation.7.See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.