Presentation
Diabetic, silent MI about one month ago, severely reduced ejection fraction on echocardiography.
Patient Data
Coronary angiography (not shown)
Balanced supply (coronary codominance)
Right coronary artery (RCA)
significant concentric stenosis of the proximal posterior descending artery (PDA)
Left anterior descending artery (LAD)
significant stenoses of the proximal and medial LAD (incl. bifurcation lesion at the origin of D2)
concentric near-occlusion of the distal LAD
Circumflex artery (CX)
concentric stenosis of the distal CX
significant stenosis of the left posterolateral branch
Heart rate: irregular 80-130 bpm
Image quality: respiratory and arrhythmia artifacts, otherwise no limitations
Functional analysis of the left ventricle (endo-volume):
EDVI: 190 mL/m²
ESVI: 150 mL/m²
SVI: 40 mL/m²
EF: 21%
cardiac output: 7.6 L/min
cardiac index: 3.4 L/min/m²
ED wall mass index (without papillary muscles): 87 g/cm²
septum thickness: 12 mm
Findings:
Dilated cardiac apex with akinetic apical segments and midventricular septal and inferior segments with concomitant extensive transmural late gadolinium enhancement (LGE) in those segments.
Due to motion artifacts T1 mapping was not helpful in this case other than for delineation of the thrombus in the source sequences.
Minimal bilateral pleural effusions.
Impression:
ischemic cardiomyopathy with extensive transmural scar of the left ventricular apex as well as the midvenricular septal and inferior segments with giant apical aneurysm and huge left ventricular thrombus
heart failure with highly reduced ejection fraction
Exam courtesy: Sven Winzler (imaging technologist)
Case Discussion
A case of ischemic cardiomyopathy with heart failure with reduced ejection fraction (HFrEF) due to multivessel coronary artery disease.
The case also features complications such as a giant apical aneurysm due to adverse remodeling, as well as a large left ventricular intracardiac thrombus. Due to the extensive transmural myocardial scarring, coronary revascularization was not performed and the patient received medical treatment with sacubitril-valsartan, spironolactone, ß-blockers as well as aspirin in addition to her diabetes medication.
Unable to process the form. Check for errors and try again.