34 yo F with HIV on HAART, depression, new onset HFrEF, tachycardia and chest pain. Referred for cardiac MRI to rule out infiltrative vs ischemic disease vs myocarditis.MEDICATIONS: abacavir, dolutegravir, lamivudine, albuterol, captopril, ASA, diphenhydramine, nystatin, fluticasone, furosemide, nicotine patch. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 150 ml/m2 (normal range: 65+/-11), the LVEDV is 253 ml (normal range 109+/-23), the LV end systolic volume index is 124 ml/m2 (normal range 18+/-5), the LVESV is 209 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 110 g. There is global hypokinesis. The native T1 myocardial relaxation time is <1100 ms suggestive of absence of underlying fibrosis, infiltration or inflammation.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 111 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 drain normally into the right atrium. PericardiumThere is a trivial 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. No perfusion defects/ "ischemia" present during hyperemia.2. No late gadolinium enhancement. No prior myocardial infarction. The entire myocardium is viable.3. Severely dilated LV with severely reduced global systolic function (LVEF 17 %).4. Normal RV size with mildly reduced systolic function (RVEF 48%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.