56 year old man with history of cardiomyopathy, PVCs, and possible ARVD is referred for reassessment. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 237 ml (normal range 142+/-34), the LV end systolic volume index is 70 ml/m2 (normal range 25+/-9), the LVESV is 149 ml (normal range 47+/-19), the LV mass index is 90 g/m2 (normal range 85+/-15), and the LV mass is 190 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement of the basal inferior wall and transmural late gadolinium enhancement of the apical lateral wall. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Although on the current study, the pattern of LGE could be seen with prior myocardial infarction, on the prior study, which had better image quality, the LGE pattern was epicardial and not consistent with prior myocardial infarction.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. There is dyskinesis of the RV base and evidence of RV apical late gadolinium enhancement. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 173 ml/m2 (normal range 82+/-16), the RVEDV is 366 ml (normal range 142+/-31), the RV end systolic volume index is 132 ml/m2 (normal range 31+/-9), and the RVESV is 280 ml (normal range 54+/-17). In the appropriate clinical setting, these findings support the diagnosis of arrhythmogenic right ventricular cardiomyopathy. Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant 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.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. When compared to the prior study both ventricles are larger and have a lower ejection fraction.2. Severe right ventricular dilation with severely reduced systolic function (RVEF 23%). There is dyskinesis of the RV base and evidence of RV apical late gadolinium enhancement. In the appropriate clinical setting, these findings support the diagnosis of arrhythmogenic right ventricular cardiomyopathy.3. Mild LV dilation with moderately reduced systolic function (LVEF 37%). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement of the basal inferior wall and transmural late gadolinium enhancement of the apical lateral wall. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Although on the current study, the pattern of LGE could be seen with prior myocardial infarction, on the prior study, which had better image quality, the LGE pattern was epicardial and not consistent with prior myocardial infarction.4. Moderate right atrial dilation.The findings of the LV and RV most likely represent the same process. ARVD can involve the LV as well as the RV. Also many LV cardiomyopathies can involve the RV and be mistaken for findings of ARVD.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.