61 year old man with history of ischemic cardiomyopathy s/p heart transplant in May 2015 complicated by early grade 1A rejection, now admitted after surveillance right heart catheterization demonstrated elevated filling pressures. He is referred for cardiac MRI to evaluate for possible rejection. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 153 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 33 g/m2 (normal range 85+/-15), and the LV mass is 76 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The T2-STIR ratio between myocardium and skeletal muscle is 1.9 (normal is <2). Global relative enhancement is 2.8 (normal is <4). Native T1 relaxation time is 980ms, which is not elevated. ECV is slightly elevated at 32%. There is a focus of transmural late gadolinium enhancement in the basal inferior wall which involves 1/2 of the wall thickness and could be consistent with previous infarction, infiltration, inflammation or fibrosis. Aside from this segment, there is no late gadolinium enhancement noted.Left AtriumThe left atrium is enlarged consistent with history of transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 83 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 mildly dilated (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are bilateral pleural effusions (right greater than left). There are sternotomy wires present. 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 size LV with low normal systolic function (EF 54%).2. Global relative enhancement, T2-STIR myocardium:skeletal muscle ratios and native T1 relaxation times are normal, but there is a focus of late gadolinium enhancement in the basal inferior wall. While the pattern could suggest infarction (endocardial involvement), given the patient's clinical history a infiltrative, inflammatory, or fibrotic process is also possible.3. Normal size RV with mildly reduced systolic function (EF 45%).4. Mildly dilated main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.