55 year old man with history of non-ischemic cardiomyopathy, cardiac sarcoid who presents with new drop in EF. Patient presents for cardiac MRI to evaluate cardiac function and extent of sarcoid involvement Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 12 %, the LV end diastolic volume index is 180 ml/m2 (normal range: 74+/-15), the LVEDV is 337 ml (normal range 142+/-34), the LV end systolic volume index is 157 ml/m2 (normal range 25+/-9), the LVESV is 327 ml (normal range 47+/-19), the LV mass index is 77 g/m2 (normal range 85+/-15), and the LV mass is 160 g (normal range 164+/-36). There is severe diffuse hypokinesis. There is midwall basal to mid septal late gadolinium enhancement not consistent with myocardial infarction. This is likely secondary to underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated and severely reduced in systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 269 ml (normal range 142+/-31), the RV end systolic volume index is 104 ml/m2 (normal range 31+/-9), and the RVESV is 216 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is reduced excursion of the mitral valve with moderate 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 FindingsThere is mediastinal lymphadenopathy present. 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 12%)2. There is a mid-wall stripe of basal to mid septal late gadolinium enhancement. The pattern is atypical for prior myocardial infarction and represents underlying myocardial fibrosis, inflammation, or infiltration. Given the patient's history of sarcoidosis, the underlying mechanism of the late gadolinium enhancement is likely due to sequelae of cardiac sarcoidosis. Would recommend FDG-PET to determine whether active inflammation is present and to guide potential immunosuppressive therapy.3. The right ventricle is mildly dilated and severely reduced in systolic function (RVEF 20%)4. Moderate mitral regurgitation5. Severe left atrial enlargement6. Extra-cardiac findings as above7. In comparison to the cardiac MRI performed 7/14/10, there has been a substantial decrease in systolic function.