74 year old male with a history of nonischemic cardiomyopathy s/p pacemaker, PVC ablation, atrial flutter referred for cardiac MRI. Left VentricleThe left ventricle is severely dilated with moderately reduced function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 136 ml/m2 (normal range: 74+/-15), the LVEDV is 293 ml (normal range 142+/-34), the LV end systolic volume index is 91 ml/m2 (normal range 25+/-9), the LVESV is 197 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is epicardial late gadolinium enhancement in the basal inferior and inferolateral walls which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is additionally evidence of a patch of late gadolinium enhancement with a "necrotic" core involving the most basal aspect of the anterior wall (aka the LV summit); this finding is likely secondary to the recent ablation procedure. The pattern is not typical for prior myocardial infarction. No evidence of myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 262 ml (normal range 142+/-31), the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9), and the RVESV is 121 ml (normal range 54+/-17). Pacemaker lead in RV. Right AtriumThe right atrium is mildly dilated. Pacemaker lead in the RA. Aortic ValveThe aortic valve opens widely and there is mild 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 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 FindingsA pacemaker can is noted in left upper chest. 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. Severely dilated left ventricle with moderately reduced systolic function (LVEF 33%).2. Mildly dilated right ventricle with mildly reduced systolic function (RVEF 46%)3. There is evidence of epicardial late gadolinium enhancement involving the basal inferior and inferolateral walls which suggest the presence of an underlying fibrosing inflammatory infiltrative or inflammatory process. There is additionally evidence of a patch of late gadolinium enhancement with a "necrotic" core/ microvascular obstruction involving the most basal aspect of the anterior wall (aka the "LV summit"); this finding is likely secondary to the recent ablation procedure. No evidence of prior myocardial infarction. 4. Left atrium is moderately dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.