62 year old male with newly diagnosed heart failure presenting for evaluation of nonischemic cardiomyopathy Left VentricleThe left ventricle is moderately dilated and with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 278 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 218 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 153 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is a moderate burden of late gadolinium enhancement in the basal inferior and inferoseptal walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is in a non-coronary infarct type distribution. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 119 ml/m2 (normal range 82+/-16), the RVEDV is 252 ml (normal range 142+/-31), the RV end systolic volume index is 67 ml/m2 (normal range 31+/-9), and the RVESV is 141 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilatedAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve are tethered and there is trace 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace 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. Moderate LV dilation with severely reduced systolic function (LVEF 22%) with evidence of a moderate burden of late gadolinium enhancement involving the mid-myocardium of the basal inferior and inferoseptum. The pattern is atypical for prior myocardial infarction and suggests the presence of myocardial fibrosis, inflammation, or infiltration. The differential diagnosis of this finding is broad and includes various types of myocarditis (viral, sarcoid, etc) among other things.2. Mild RV dilation with mildly reduced systolic function (RVEF 44%).3. Severe left atrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.