59 year old woman with history of known heart failure, mild coronary disease, diabetes and previous breast cancer referred for cardiac MRI to evaluate for possible etiologies of her LV dysfunction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 159 ml/m2 (normal range: 65+/-11), the LVEDV is 302 ml (normal range 109+/-23), the LV end systolic volume index is 118 ml/m2 (normal range 18+/-5), the LVESV is 225 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 102 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is are two patterns of late gadolinium enhancement. The first is a mid-wall stripe pattern involving much of the septum. This pattern is most consistent with fibrosis due to non-ischemic cardiomyopathy. The second is a small focal area of transmural late gadolinium enhancement involving the mid inferior wall. This pattern could represent either an embolic myocardial infarction, vasculitis, or fibrosis. The native T1 myocardial relaxation time is 1180-1240ms. The extracellular volume fraction is 36%. These values are elevated, suggestive of the presence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated. The interatrial septum bows to the right, consistent with elevated left atrial filling pressures. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 61 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. There is moderate 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 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. There is a trivial pericardial effusion.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. Severe LV dilation with severely reduced systolic function (LVEF 26%) with two patterns of late gadolinium enhancement. The first is a mid-wall stripe pattern involving much of the septum. This pattern is most consistent with fibrosis due to non-ischemic cardiomyopathy. The second is a small focal area of transmural late gadolinium enhancement involving the mid inferior wall. This pattern could represent either an embolic myocardial infarction, vasculitis, or fibrosis. 2. Normal RV size with mildly reduced systolic function (RVEF 49%).3. Moderate mitral regurgitation.4. Severe left atrial dilation .I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.