50 year old woman with history of HFpEF who presents for cardiac MRI to evaluate for restrictive cardiomyopathy Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 90 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 32 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 111 g (normal range 114+/-24). There is mild systolic flattening of the interventricular septum suggesting increased RV systolic pressure.Aside form the mild late gadolinium enhancement of the anterior and inferior RV insertion points, which is well described and common in patients with pulmonary hypertension, there is no other late gadolinium enhancement of the myocardium or pericardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. It is moderately hypertrophied. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is severely 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.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation. There is aliasing of the tricuspid regurgitation jet suggesting increased TR velocity.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 mild to moderately dilated (34 mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is moderate sized pericardial effusion. There is no enhancement of the pericardium on late gadolinium imaging.Extracardiac FindingsThere is moderate sized right pleural effusion with evidence of septation and some complex features raising the possibility that it may be exudative in nature. This effusion was not present on the prior study. There is a trace left pleural effusion. 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. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%) with significant hypertrophy and evidence of mild systolic flattening of the interventricular septum and late gadolinium enhancement of the anterior and inferior RV insertion points. All of these findings are consistent with the patients known history of pulmonary hypertension. 4. Severe biatrial dilation5. Moderate tricuspid regurgitation6. Mild aortic regurgitation7. Moderate sized pericardial effusion (slightly larger than on the prior study)8. Mild to moderately dilated main pulmonary artery (34 mm)9. In comparison to the cardiac mri done on 7/8/10, there is now a complex appearing right pleural effusion. The cardiac structures are essentially unchanged with the exception of mild late gadolinium enhancement involving the RV insertion points. 