59 year old man with history of metastatic lung SCC s/p carbo/taxol, docetaxel, and PF 6647020 (PTK7 antibody-drug-conjugate, C2 2/4/15) c/b malignant pleural effusions who was found to have a drop in ejection fraction. Cardiac MRI done to evaluate function and etiology of cardiomyopathy. Left VentricleThe left ventricle is normal in size and mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 127 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 73 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 68 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 ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary Veins3 pulmonary veins drain normally into the left atrium (the LUPV was not well visualized)Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is an SVC catheter.PericardiumThere is a moderate sized pericardial effusion. There is diastolic compression seen of the right atrium and RV. There is delayed enhancement of the visceral pericardium of unclear significance.Extracardiac FindingsExtensive metastatic lymphadenopathy in the thorax, chest wall and abdomen. Left lung mass. Large sized pleural effusions seen; left greater than right. 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 normal in size with mildly reduced systolic function (43%). 2. The right ventricle is normal in size and systolic function (50%)3. Moderate sized pericardial effusion with diastolic compression of the right atrium and RV.4. Extra-cardiac findings as above.