57 year old male with low ejection fraction, normal coronary angiogram, evaluate etiology of cardiomyopathy Left VentricleThe left ventricle is severely dilated with severely decreased function. The overall LV ejection fraction is 20%. The LVEDV is 357 ml (normal range 142+/-34), the LV end diastolic volume index is 204 ml/m2 (normal range: 74+/-15), the LVESV is 287 ml (normal range 47+/-19) and the LV end systolic volume index is 164 ml/m2 (normal range 25+/-9). The LV mass is 207 g (normal range 164+/-36) and the LV mass index is 118 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is a mid-wall pattern of late gadolinium enhancement involving the basal to mid septum which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The pattern is classically thought to be fibrosis associated with dilated cardiomyopathy. The native T1 myocardial relaxation time is [1090]ms, which is borderline increased and consistent with the presence of underlying myocardial fibrosis. No evidence of left ventricular thrombus.No evidence of myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderate to severely dilated with moderately decreased function. The overall RV ejection fraction is 31%. The RVEDV is 253 ml (normal range 142+/-31), RV end diastolic volume index is 145 ml/m2 (normal range 82+/-16), the RVESV is 176 ml (normal range 54+/-17), and the RV end systolic volume index is 100 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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. Severely dilated left ventricle with severely reduced ejection fraction of 20%.2. Moderate to severely dilated right ventricle with moderately reduced ejection fraction of 31%.3. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The pattern is classically thought to be fibrosis associated with dilated cardiomyopathy. 4. Moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.