A 67 year old male with history of coronary artery disease, s/p PCI X3 to LCx (2005), hyperlipidemia, left ventricular dysfunction, cardiomyopathy suspected to be secondary to frequent PVC's, s/p attempted ablation (endo and epicardial). A recent echocardiography showed LVEF of 44.7%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 176 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 122 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). Due to frequent PVC's, volumetric quantification is limited. On late gadolinium enhancement images, there is transmural hypoperfusion of the basal to mid anterior wall (i.e. along the left ventricular summit) with a thin rim of hyperenhancement consistent with microvascular obstruction from the patient's recent ablation procedure. There is no myocardial iron overload. No intracavitary thrombus was noted.Left AtriumThe left atrium is moderately dilated (126ml). Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 105 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly 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. There is mitral annulus calcification and thickening of the leaflets.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 a trace pericardial effusion, mainly around the RV and RA. Extracardiac FindingsBilateral small pleural effusions were 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. The left ventricle is normal in size with moderately reduced systolic function, the LVEF is 31%. However, quantification is limited by frequent PVC's. 2. On late gadolinium enhancement images, there is transmural hypoperfusion of the basal to mid anterior wall (i.e. along the left ventricular summit) with a thin rim of hyperenhancement consistent with microvascular obstruction from the patient's recent ablation procedure. 3. There is biatrial dilation. 4. The right ventricle is normal in size with moderately reduced systolic function, the RVEF is 37%. 5. There is mitral annulus calcification and thickening of the leaflets. No significant MR was seen.6. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.