36 year old woman with newly diagnosed non ischemic cardiomyopathy referred for cardiac MRI to evaluate for possible etiologies. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 162 ml/m2 (normal range: 65+/-11), the LVEDV is 363 ml (normal range 109+/-23), the LV end systolic volume index is 123 ml/m2 (normal range 18+/-5), the LVESV is 274 ml (normal range 31+/-10), the LV mass index is 72 g/m2 (normal range 67+/-11), and the LV mass is 161 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a mid-wall stripe pattern of late gadolinium enhancement in the interventricular septum and a patchy pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. These patterns are not typical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is commonly described in dilated cardiomyopathy due to old myocarditis but is also seen in other forms of non-ischemic cardiomyopathy. No evidence of cardiac amyloidosis or myocardial iron overload. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 99 ml/m2 (normal range 69+/-14), the RVEDV is 222 ml (normal range 110+/-24), the RV end systolic volume index is 75 ml/m2 (normal range 22+/-8), and the RVESV is 167 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 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 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 a small 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 24%) with evidence of a mid-wall stripe pattern of late gadolinium enhancement in the interventricular septum and a patchy pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. These patterns are not typical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is commonly described in dilated cardiomyopathy due to old myocarditis but is also seen in other forms of non-ischemic cardiomyopathy. 2. Normal RV size with severely reduced systolic function (RVEF 25%).3. Severe LA dilation.4. Mild to moderate mitral regurgitation.5. Small pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.