79 year old man with cardiac amyloid (newly diagnosed) referred for cardiac MRI to evaluate function and amyloid burden. Left VentricleThe left ventricle is normal in size with moderate circumferential left ventricular hypertrophy (IVSd and PWd=15mm). The systolic function is mild to moderately reduced. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 163 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 97 ml (normal range 47+/-19), the LV mass index is 84 g/m2 (normal range 85+/-15), and the LV mass is 181 g (normal range 164+/-36). There are global hypokinesis with relative sparing of the apical segments. The LV cavity and myocardium null at nearly the same time. There is diffuse circumferential late gadolinium enhancement which involves the endocardium surface and a little more than half of the wall thickness. The native myocardial T1 time is moderately elevated to 1179ms. All of these findings strongly support the diagnosis of cardiac amyloidosis. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 252 ml (normal range 142+/-31), the RV end systolic volume index is 81 ml/m2 (normal range 31+/-9), and the RVESV is 174 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.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 mild 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 a trivial pericardial effusion.Extracardiac FindingsThere are increased interstitial lung markings noted. 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. Moderate left ventricular hypertrophy with mild to moderately reduced systolic function (LVEF 41%). Late gadolinium enhancement pattern diagnostic for cardiac amyloidosis.2. Mild right ventricular dilation with moderate to severely reduced systolic function (RVEF 31%)3. Severe biatrial dilation.4. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.