60 year old man with known coronary artery disease referred to evaluate viability. Left VentricleThe left ventricle is normal in size and systolic function. There is akinesis of the mid to apical anterior wall and dyskinesis of the apical cap. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 201 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 80 g/m2 (normal range 85+/-15), and the LV mass is 182 g (normal range 164+/-36). There are two distinct regions of late gadolinium enhancement. The larger is a transmural myocardial infarction involving the mid to apical anterior wall and the apical septum. These segments are not likely to be viable. There is an atypical pattern or late gadolinium enhancement (non-myocardial infarction pattern) involving the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction and suggests the presence of a secondary underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 73%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 51 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 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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. Normal LV size with normal systolic function (LVEF 55%). There is akinesis of the mid to apical anterior wall and dyskinesis of the apical cap. 2. There are two distinct regions of late gadolinium enhancement. The larger is a transmural myocardial infarction involving the mid to apical anterior wall and the apical septum. These segments are not likely to be viable. There is an atypical pattern or late gadolinium enhancement (non-myocardial infarction pattern) involving the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction and suggests the presence of a secondary underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable. 3. Normal RV size and systolic function (RVEF 73%).