52 year old man with history of non-ischemic cardiomyopathy with previous LV dysfunction, now recovered but with significant hypertrophy and ICD, referred for cardiac MRI to evaluate for possible scar Left VentricleThe left ventricle is severely hypertrophied (basal septal thickness 16mm) in a concentric pattern. The systolic function is normal, but due to artifact cardiac volumes cannot be calculated. Visually it is LVEF 60-65%. On late gadolinium enhancement imaging, a small portion of the mid anterior wall can not be evaluate due to artifact from the ICD. There is a small patch of late gadolinium enhancement involving the apical inferolateral wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. The pattern is not suggestive of prior myocardial infarction or cardiac amyloidosis. Less than 5% of the myocardium has late gadolinium enhancement. Left AtriumThe left atrium is grossly normal in size. Right VentricleThe right ventricle is normal in size and systolic function. An ICD lead is noted in the right ventricle. Right AtriumThe right atrium is not well visualized.Aortic ValveThe aortic valve is not well seen.Mitral ValveThe mitral valve is not well seen.Pulmonic ValveThe pulmonic valve is not well seen.Tricuspid ValveThe tricuspid valve is not well seen. AortaThere is a left sided aortic arch. Venous AnatomyThe SVC and IVC are not well seen PericardiumThere is a trivial pericardial effusion. Extracardiac FindingsThere is a defibrillator lead in the RV and pulse generator in the chest wall with associated artifact . 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, concentric left ventricular hypertrophy with normal systolic function (LVEF 60-65%). Less than 5% of the myocardium has late gadolinium enhancement. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction or cardiac amyloidosis but does suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Because of artifacts from the ICD, a small amount of mid anterior wall myocardium could not be adequately evaluated. 2. Normal RV size and systolic function. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.