66 year old man referred to evaluate for suspected hypertrophic cardiomyopathy. Left VentricleThe left ventricle has moderate to severe hypertrophy, predominantly involving the mid to apical levels. There is mild left ventricular hypertrophy of the basal level. The maximum wall thickness at the apex is approximately 18mm; however, patient inability to cooperate with breath-holds limits the accuracy of this measurement. The overall LV systolic function is low normal. The LV ejection fraction is 54%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 182 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 110 g/m2 (normal range 85+/-15), and the LV mass is 266 g (normal range 164+/-36). There is patchy late gadolinium enhancement which involves the apical anterior and inferior wall. The late gadolinium enhancement spares the endocardium and the pattern is atypical for prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Qualitatively, there is a moderate burden of late gadolinium enhancement.Left AtriumThe left atrium is severely dilated. The interatrial septum is aneurysmal. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 175 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 81 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 moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small 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. The left ventricular is moderately hypertrophied with regional variation in a pattern that is supportive of the diagnosis of apical variant of hypertrophic cardiomyopathy. The overall systolic function is low normal (LVEF 54%).2. Normal RV size and systolic function (RVEF 54%).3. There is a moderate overall burden of late gadolinium enhancement involving the apical anterior and inferior walls. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Severe left atrial dilation.5. Moderate mitral regurgitation. 6. Moderate dilation of main pulmonary artery.7. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.