28 year old man with history of recently diagnosed biventricular dysfunction who was admitted with cardiogenic shock, referred now for cardiac MRI to evaluate for possible etiologies of his non-ischemic cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 212 ml/m2 (normal range: 74+/-15), the LVEDV is 427 ml (normal range 142+/-34), the LV end systolic volume index is 182 ml/m2 (normal range 25+/-9), the LVESV is 368 ml (normal range 47+/-19), the LV mass index is 95 g/m2 (normal range 85+/-15), and the LV mass is 191 g (normal range 164+/-36). Wall motion is globally hypokinetic. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Artefact makes detailed evaluation of LV myocardium difficult on T2* imaging; there were no gross abnormalities appreciated in T2* sequences. There is an LV thrombus at the apex. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severe systolic dysfunction. The overall RV ejection fraction is 18%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 219 ml (normal range 142+/-31), the RV end systolic volume index is 89 ml/m2 (normal range 31+/-9), and the RVESV is 180 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 opens widely and there moderate-severe mitral regurgitation. This appears most evident on the short-axis views, and was not corroborated well on the 4-chamber cine.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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.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. Globular heart with severe LV dilatation.2. Severely reduced biventricular function (LVEF = 14%; RVEF = 18%)3. LV thrombus is noted at the apex4. Moderate-severe mitral regurgitation5. Small pericardial effusion 6. No late gadolinium enhancement to suggest the presence of infiltrative, inflammatory or fibrosis disease of the myocardium. 