A 42 year old female with personal and familiar history of dilated cardiomyopathy, paroxysmal atrial fibrillation. A recent echocardiography showed left ventricular ejection fraction of 34%. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: Carvedilol, Enalapril, Spironolactone, Escitalopram First Pass PerfusionDuring hyperemia, no perfusion defects were present.Myocardial ScarThere is no evidence of prior myocardial infarction or replacement myocardial fibrosis, inflammation, or infiltration based on late gadolinium enhancement imaging. However, the native myocardial T1-times are mildly elevated suggesting the presence of mild, diffuse interstitial fibrosis. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 230 ml (normal range 109+/-23), the LV end systolic volume index is 78 ml/m2 (normal range 18+/-5), the LVESV is 147 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 66 g. There is global hypokinesis with regional variation. The LV wall is very thin and associated with increased trabeculation. Minimal criteria for the diagnosis of LV non-compaction cardiomyopathy are met. No LV cavity thrombus is noted. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 70 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 and there is mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 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. No perfusion defects/ "ischemia" present during hyperemia.2. There is no evidence of prior myocardial infarction or replacement myocardial fibrosis, inflammation, or infiltration. However, the native myocardial T1-times are mildly elevated suggesting the presence of mild, diffuse interstitial fibrosis. 3. Severe LV dilation with moderately reduced systolic function (LVEF 36%). The LV wall is very thin and associated with increased trabeculation. Minimal criteria for the diagnosis of LV non-compaction cardiomyopathy are met4. Normal RV size and systolic function (RVEF 56%).5. Moderate LA dilation.6. Mild mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.