70 year old man with history of recent diagnosis of cardiomyopathy with EF of 20% and no obstructive coronary disease by angiography, now referred for cardiac MRI to assess for possible etiologies as part of an advanced HF therapies evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 194 ml/m2 (normal range: 74+/-15), the LVEDV is 438 ml (normal range 142+/-34), the LV end systolic volume index is 163 ml/m2 (normal range 25+/-9), the LVESV is 368 ml (normal range 47+/-19), the LV mass index is 99 g/m2 (normal range 85+/-15), and the LV mass is 224 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement in the inferoapical, anteroapical and true apex with thinning suggestive of previous infarction. There is transmural late gadolinium enhancement in the basal inferolateral wall. There is no LV thrombus. In a 4-chamber view there outpouching at the apex compatible with apical aneurysm. Left AtriumThe left atrium is severely dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. There is severe hypokinesia of the apical one half of the right ventricle. The basal one half demonstrates moderate to severe hypokinesia. The overall RV ejection fraction is 13%, the RV end diastolic volume index is 157 ml/m2 (normal range 82+/-16), the RVEDV is 355 ml (normal range 142+/-31), the RV end systolic volume index is 136 ml/m2 (normal range 31+/-9), and the RVESV is 307 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered. There is at least moderate mitral regurgitation which appears eccentric. Pulmonic ValveThe pulmonic valve opens widely. There is pulmonary regurgitation, visually this appears trace or mild.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 measures 37mm at the level of pulmonary artery bifurcation. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (38mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are bilateral shoulder prostheses present. A portion of the splenic flexure is visualized. There is evidence of diverticulosis without diverticulitis.
1. Severely dilated left ventricle with severely reduced systolic function (EF = 16%). 2. There is thinning of the apex with transmural late gadolinium enhancement suggestive of previous infarction. This speaks to an ischemic component to his cardiomyopathy. 3. Suspected left ventricular apical aneurysm. 4. Severely dilated right ventricle with severely reduced systolic function (EF = 13%).5. Mitral leaflet tethering with at least moderate mitral regurgitation. 6. Dilated pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.