A 24 year old male patient with known non-ischemic cardiomyopathy, severe left ventricular dysfunction, with a lifevest, referred to cardiac MRI for evaluation of etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 187 ml/m2 (normal range: 74+/-15), the LVEDV is 477 ml (normal range 142+/-34), the LV end systolic volume index is 151 ml/m2 (normal range 25+/-9), the LVESV is 385 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 225 g (normal range 164+/-36). The myocardium is thin and there is global hypokinesis with regional variation. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process; however, due to patient related issues, the image quality is somewhat noisy.No iron overload.Findings not compatible with amyloid. The left ventricle is hyper-trabeculated up to the level of the papillary muscles. This finding could support the diagnosis of left ventricular non-compaction.No LV thrombus is noted.Left AtriumThe left atrium is severely dilated (184 ml). The inter-atrial septum bows to the left suggesting increased left atrial pressure.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 268 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 182 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely, it is bicuspid with fusion of the right and non-coronary cusp and there is mild to moderate aortic regurgitation (regurgitant volume 12ml, regurgitant fraction 16%). There is systolic doming of the aortic leaflets, consistent with bicuspid aortic valve.Mitral ValveThe mitral valve opens widely and there mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta was approximately 30mm in dimension.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. The left ventricle is severely dilated with severely reduced systolic function, LVEF 19%. The left ventricle is hyper-trabeculated up to the level of the papillary muscles. In the appropriate clinical scenario, this finding could support the diagnosis of left ventricular non-compaction.2. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No iron overload. Findings also not compatible with amyloid. 3. The right ventricle is normal in size with moderately reduced systolic function, RVEF 32%. 4. The left atrium is severely dilated (184 ml) and the right atrium is mildy dilated.5. The aortic valve is bicuspid with fusion of the right and non-coronary cusp and there is mild to moderate aortic regurgitation.