67 year old man with cardiomyopathy referred to rule out cardiac amyloid. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. Wall thickness is normal. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 293 ml (normal range 142+/-34), the LV end systolic volume index is 100 ml/m2 (normal range 25+/-9), the LVESV is 222 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 156 g (normal range 164+/-36). There is global hypokinesis with regional wall variation present. There is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal inferolateral wall (epicardial pattern) and the basal to mid anteroseptum (mid-wall pattern) which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. It has been commonly described to represent old myocarditis and also fibrosis in dilated cardiomyopathy. No evidence of cardiac iron overload or cardiac amyloidosis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 163 ml/m2 (normal range 82+/-16), the RVEDV is 361 ml (normal range 142+/-31), the RV end systolic volume index is 117 ml/m2 (normal range 31+/-9), and the RVESV is 260 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated. The interatrial septum is aneurysmal and bows to the left suggesting increased right atrial pressures.Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe 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 small pericardial effusion.Extracardiac FindingsLarge right pleural effusion, small left pleural effusion, left renal cyst. 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. Severe LV dilation with severely reduced systolic function (LVEF 24%).2. Severe RV dilation with severely reduced systolic function (RVEF 28%).3. There is mid-wall and epicardial late gadolinium enhancement involving the basal inferolateral wall and the basal to mid anteroseptum. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying fibrosis, inflammation or infiltration. The pattern has been commonly described in old myocarditis and in fibrotic stage dilated cardiomyopathy. There is no cardiac MRI evidence of myocardial iron overload or cardiac amyloid. 4. Severe biatrial dilation. 5. Moderate to severe tricuspid regurgitation. 6. Mild dilation of main pulmonary artery. 7. Mild to moderate aortic regurgitation. 8. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.