62 year old man with OHT, referred for evaluation of underlying rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time is moderately elevated and the ECV fraction is mildly elevated, both in a diffuse non-focal pattern.T2 ratio = 1.6 (<2 normal)Global relative enhancement ratio = 3.2 (<4 normal)Native myocardial T1 = 1167ms (<1050ms normal)Native LV cavity T1 = 1668msECV Fraction = 32% (20-30% normal)Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 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 FindingsModerate sized right 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 left ventricular size and systolic function (LVEF 61%) without evidence of underlying myocardial replacement fibrosis. However, native myocardial T1 times are moderately elevated and the ECV fraction is mildly elevated (see values above). A recent publication (Miller et al. JCMR 2014;16:52) suggests that the native T1 time by 3 months is expected to be 1089 +/-62ms and the ECV is 30.1+/- 0.5%. 2. Normal right ventricular size and systolic function (RVEF 54%).3. Moderate sized right pleural effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.