72 year old with history of nonischemic cardiomyopathy presenting for evaluation for fibrosis/scar and to accurately measure ejection fraction. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 151 ml/m2 (normal range: 74+/-15), the LVEDV is 326 ml (normal range 142+/-34), the LV end systolic volume index is 102 ml/m2 (normal range 25+/-9), the LVESV is 219 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 144 g (normal range 164+/-36). There is septal bounce, otherwise the LV dysfunction is global with regional variation, involving the basal LV more than the apex. There is an area of nearly transmural late gadolinium enhancement involving the basal inferolateral wall in a pattern that is typical for myocardial infarction and the involved segments are unlikely to be viable. There is additionally a mid-wall stripe of septal late gadolinium enhancement which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This second pattern of late gadolinium enhancement has been described in a variety of cardiomyopathies such as old myocarditis or dilated cardiomyopathy. There is no cardiac iron overload. No evidence of LV thrombus. Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 (32 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge right renal cyst is noted. 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. Severe LV dilation with moderately reduced systolic function (LVEF 33%). The etiology is potentially mixed ischemic and non-ischemic given the presence of two distinct patterns of late gadolinium enhancement.2. Nearly transmural myocardial infarction involving the basal inferolateral wall. This segment is not likely to be viable.3. Normal RV size and systolic function (RVEF 51%).