A 62 year old male with personal history of hypertension and s/p mitral valve repair (2013). Recently had an episode of syncope with positive troponin, the echocardiography showed normal functioning mitral valve and myocardial hypertrophy with suspected hypertrophic cardiomyopathy without flow acceleration. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 122 g (normal range 164+/-36). There is mild to moderate left ventricular hypertrophy (maximum of 13mm at the basal anteroseptum).Despite normal left ventricular systolic function, there is decreased myocardial deformation (tagging sequences, mainly at the base to mid segments). There is late gadolinium enhancement at the superior and inferior insertion points of the right ventricle. This finding suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is also subendocardial LGE involving the basal to mid lateral wall. Although subendocardial late gadolinium enhancement could represent myocardial infarction, in this case it is within thickened myocardium suggesting that it represents an infiltrative or inflammatory process. The native myocardial T1 times are increased in the basal to mid segments (1100-1200ms), which could represent myocardial edema or fibrosis.No acceleration of the flow was noted in the left ventricular outflow tract or systolic anterior motion of the mitral leaflet.Left AtriumThe left atrium is mildly dilated (101ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 148 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveA ring was seen at the mitral valve annulus, the valve opens widely and there is mild mitral regurgitation.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 mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires were 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. The left ventricle is normal in size and systolic function, the LVEF is 60%. There is mild to moderate left ventricular hypertrophy (maximum of 13mm at the basal anteroseptum). Despite normal left ventricular systolic function, there is decreased myocardial deformation (tagging sequences, mainly at the base to mid segments). There is additionally late gadolinium enhancement as described above and increased native myocardial T1 relaxation time which were both most pronounced at the base of the left ventricle. These findings most likely represent an underlying myocardial infiltrative or inflammatory process. 2. The diagnosis of hypertrophic cardiomyopathy is less likely given the absence of wall thickness 15mm or more, LVOT flow acceleration, and systolic anterior motion of the mitral leaflet; however, the possibility that these findings represent early hypertrophic cardiomyopathy can not be completely excluded. 3. Mild biatrial dilation. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. 5. A ring was seen at the mitral valve annulus, with normally functioning valve. 6. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.