64 year old woman with history of pulmonary hypertension, heart failure with preserved EF, atrial fibrillation, sick sinus syndrome with dual chamber pacemaker and worsening shortness of breath, referred for cardiac MRI to evaluate for infiltrative etiologies. Due to renal dysfunction, contrast could not be administered for this study. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 55 g/m2 (normal range 67+/-11), and the LV mass is 113 g (normal range 114+/-24). There is asymmetric hypertrophy of the left ventricle with pronounced hypertrophy of the apical anterior, anterolateral and inferolateral walls (15mm) with normal septal thickness (8-9mm). There is mid cavity obliteration at end-systole but no frank flow acceleration to suggest an intracavitary gradient. Additionally, there appears to be an apical aneurysm which is thinning and akinetic. The native T1 myocardial relaxation time, including for the hypertrophied segments, is 850-950ms which is normal.Left AtriumThe left atrium is severely dilated. There appears to be flow across the interatrial septum (left to right) which could represent a patent foramen ovale.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 112 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). There is a pacemaker lead visualized in the right ventricle.Right AtriumThe right atrium is moderately dilated. There is a pacemaker lead that terminates in the right atrium. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflet tips are thickened. There is at least mild mitral regurgitation. There is no systolic anterior motion of the mitral valve.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 moderately dilated (34mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium. There are intravascular device leads in the SVC.PericardiumThere is no pericardial effusion. There is pericardial thickening overlying the anterolateral wall. Extracardiac FindingsThere is a pacemaker with associated artifact overlying the left upper chest wall. 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. Normal size left ventricle with hyperdynamic systolic function. There is asymmetric hypertrophy involving the apical lateral, anterior and inferolateral walls with a maximal thickness of 15-16mm, which could suggest an atypical hypertrophic cardiomyopathy variant. This is supported by a normal septal wall thickness (8-9mm).2. There is an apical aneurysm noted. Evaluation for LV thrombus on this study is limited by inability to administer contrast.3. Normal size right ventricle with normal systolic function. 4. Dual chamber intracardiac device with leads visualized in the right atrium and right ventricle. 5. Left to right flow across the interatrial septum suggestive of patent foramen ovale. 6. Focal thickening of the pericardium overlying the anterolateral wall. 7. At least mild mitral regurgitation, but no evidence of systolic anterior motion of the mitral valve. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.