58 year old with ischemic cardiomyopathy with increasing amounts of non-sustained ventricular tachycardia presenting for evaluation of scar and viability. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVEDV is 266 ml (normal range 142+/-34), the LV end systolic volume index is 82 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). There are regional wall motion abnormalities in the apex, apical to mid septal, inferior and anterior walls. There is extensive transmural late gadolinium enhancement in the apex, mid to apical anterior, septal and distal inferior walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is typical for myocardial infarction. Left AtriumThe left atrium is moderate to severely enlarged. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 227 ml (normal range 142+/-31), the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9), and the RVESV is 113 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate to severely dilated.Aortic ValveThe aortic valve opens widely and there is mild 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 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 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. The left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 43%. There are regional wall motion abnormalities in the apex, apical to mid septal, inferior and anterior walls. There is extensive transmural late gadolinium enhancement in the apex, mid to apical anterior, septal and distal inferior walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is typical for myocardial infarction. 2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.