57 year old man with no significant cardiac history and recent dyspnea with exertion, found to have new systolic dysfunction on echocardiogram with question of non-compaction. He was referred for cardiac MRI to evaluate for etiologies of his cardiomyopathy. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 249 ml (normal range 142+/-34), the LV end systolic volume index is 98 ml/m2 (normal range 25+/-9), the LVESV is 192 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There is global hypokinesis. There is no apical thrombus. The ratio of non-compacted to compacted myocardium is 1.5, which is not consistent with a diagnosis of ventricular non-compaction. T2 STIR sequences do not demonstrate evidence of myocardial edema. There is subepicardial late gadolinium enhancement noted in the anteroseptum and inferoseptum, from the basal to mid portion. Additionally there is possible subepicardial late gadolinium enhancement in the anterolateral wall. This is atypical for infarction, but is consistent with an underlying fibrosing, infiltrative, or inflammatory process, such as prior myocarditis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 120 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 96 ml/m2 (normal range 31+/-9), and the RVESV is 189 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve is trileaflet and opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bileaflet tethering and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 12 x 12 mm rounded area of increased signal intensity in the lateral aspect of the liver, which is non-enhancing and may warrant further dedicated imaging. 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. Moderately dilated left ventricle with severely reduced systolic function (EF 23%).2. No evidence of LV noncompaction.3. There is subepicardial late gadolinium enhancement noted in the anteroseptum and inferoseptum, from the basal to mid portion. Additionally there is possible subepicardial late gadolinium enhancement in the anterolateral wall. This is atypical for infarction, but is consistent with an underlying fibrosing, infiltrative, or inflammatory process. The constellation of findings could be consistent with a prior myocarditis.4. Mildly dilated right ventricle with severely reduced systolic function (EF 20%).5. Mild to moderate mitral and tricuspid regurgitation.6. Biatrial enlargement 7. Mildly dilated main PA8. See extra cardiac findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.