37 year old with history of ischemic cardiomyopathy referred to assess burden of scar and LV ejection fraction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is a large territory of akinesis involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior, septum, and inferior walls. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 152 ml/m2 (normal range: 74+/-15), the LVEDV is 277 ml (normal range 142+/-34), the LV end systolic volume index is 116 ml/m2 (normal range 25+/-9), the LVESV is 212 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 88 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a large transmural region of late gadolinium enhancement in a myocardial infarction pattern involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior, septum, and inferior walls. These segments are not viable. The remainder of the myocardium is free of myocardial infarction and is viable. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 98 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 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 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. Severe LV dilation with severely reduced systolic function (LVEF 24%). There is a large wall motion abnormality with associated scar involving most of the LAD territory. This territory is unlikely to be viable. The remainder of the myocardium (including the territory of a likely large diagonal artery or a ramus intermedius artery) is free of myocardial infarction and likely to be viable.2. Normal RV size with mildly reduced systolic function (RVEF 46%). 3. Severe left atrial dilation. 