76 year old female admitted with possible CVA, DOE, elevated BNP with EF 18% on TTE of unclear etiology. Referred for cardiac MRI to rule out infiltrative disorders and RV thrombus. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 18%. The systolic dysfunction is global. There are no regional wall motion abnormalities present. The LVEDV is 221 ml (normal range 109+/-23), LV end diastolic volume index is 132 ml/m2 (normal range: 65+/-11), LVESV is 181 ml (normal range 31+/-10), and LV end systolic volume index is 108 ml/m2 (normal range 18+/-5). The LV mass is 166 g (normal range 114+/-24) and the LV mass index is 99 g/m2 (normal range 67+/-11). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Sigmoid septum is noted and is likely age related.The native T1 myocardial relaxation time is <1050 ms suggestive of absence of underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RVEDV is 228 ml (normal range 110+/-24), the RV end diastolic volume index is 166 ml/m2 (normal range 69+/-14), the RVESV is 232 ml (normal range 35+/-13), and the RV end systolic volume index is 128 ml/m2 (normal range 22+/-8). There is no right ventricle thrombus on contrast imaging.Right AtriumThe right atrium is severely 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild 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 FindingsSmall left pleural effusion. 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. No perfusion defects/ "ischemia" present during induced hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is severely dilated with severely reduced systolic function. LVEF 18%. The systolic dysfunction is global. 4. The right ventricle is severely dilated with severely reduced systolic function. RVEF 17%.5. Severe biatrial dilation.6. Normal Native T1 myocardial relaxation time is <1050 ms suggestive of absence of underlying diffuse fibrosis or infiltration.7. No right ventricle thrombus on contrast imaging.