70 year old female with a history of hypertension, left ventricular hypertrophy, heart failure with preserved ejection fraction, prior stroke, and lupus who is referred for stress cardiac MRI for further evaluation. MEDICATIONS: Furosemide, Hydralazine, Lisinopril, Metoprolol, Rivaroxaban, Allopurinol, Symbicort, Calcitrol, Ergocalciferol. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is mid-myocardial late gadolinium enhancement present in the mid to basal inferoseptum and lateral wall. Additionally there is patchy subepiocardial late gadolinium enhancement present. Images are limited by breathing artifact. This pattern of late gadolinium enhancement is atypical for myocardial infarction and may suggest the presence of fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 107 g/m2, and the LV mass is 205 g. There is severe concentric left ventricular hypertrophy - at the mid to basal segment, the septum measures 15-16 mm and the lateral wall measures 14-15 mm. There are no regional wall motion abnormalities present. The pre-contrast native T1 myocardial relaxation times are elevated (1180 ms). Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 163 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 64 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild to moderate 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.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 moderate sized circumferential pericardial effusion.Extracardiac Findings 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. No perfusion defects/ "ischemia" present during hyperemia. 2. No prior myocardial infarction. The entire myocardium is viable. There is mid-myocardial late gadolinium enhancement present in the mid to basal inferoseptum and lateral wall. Additionally there is patchy subepiocardial late gadolinium enhancement present. Images are limited by breathing artifact. This pattern of late gadolinium enhancement is atypical for myocardial infarction and may suggest the presence of fibrosis, inflammation, or infiltration.3. The left ventricle is normal in size with normal systolic function. (LVEF 60%). The pre-contrast native T1 myocardial relaxation times are elevated (1180 ms) which could be suggestive of diffuse myocardial fibrosis. 4. The right ventricle is normal in size and systolic function (RVEF 61%).5. There is severe, concentric left ventricular hypertrophy (see above measurements).6. The left atrium is severely dilated. The right atrium is mildly dilated. 7. The mitral valve opens widely and there is at least mild to moderate mitral regurgitation.8. There is a moderate sized circumferential pericardial effusion. Hemodynamic assessment of pericardial effusion not evaluated. Suggest alternate imaging such as echocardiography. 9. Overall the findings are not typical for cardiac amyloid. Previous history of myocarditis is possible given pattern of late gadolinium enhancement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.