76 years old, female, with a history of hypertension, possible hypertrophic cardiomyopathy, recent syncope in the setting of sinus bradycardia. She is referred for cardiac MRI to evaluate LV hypertrophy and rule out infiltrative heart disease. Left VentricleThe left ventricle is normal in size and systolic function. The interventricular septum is moderate to severely hypertrophied; where as, the posterior wall is normal thickness. The LV apex is aneurysmal. The IVSd ranges between 15-18mm. The posterior wall dimension is approximately 8mm. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 107 g/m2 (normal range 67+/-11), and the LV mass is 177 g (normal range 114+/-24). There is a large transmural myocardial infarction involving the entire apical aneurysm. There is additionally diffuse late gadolinium enhancement involving much of the interventricular septum suggest the presence of an underlying myocardial fibrosing, infiltrative, or inflammatory process. These findings are strongly suggestive of the diagnosis of hypertrophic cardiomyopathy.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and hyperdynamic. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 103 ml (normal range 110+/-24), the RV end systolic volume index is 19 ml/m2 (normal range 22+/-8), and the RVESV is 31 ml (normal range 35+/-13). 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 no significant mitral regurgitation. There is evidence of mild systolic anterior motion of the mitral leaflets resulting in mild flow acceleration through the LVOT.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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.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 ventricle is normal in size and systolic function (LVEF 53%). The interventricular septum is moderate to severely hypertrophied; where as, the posterior wall is normal thickness. The LV apex is aneurysmal. There is a large transmural myocardial infarction involving the entire apical aneurysm. There is additionally extensive fibrosis (>20% of the total myocardial mass) of the interventricular septum. These findings are strongly suggestive of the diagnosis of hypertrophic cardiomyopathy.2. Normal RV size with hyperdynamic systolic function (RVEF 70%).3. Mild systolic anterior motion of the mitral valve is noted.