Mr. Stockwell presents with cardiomyopathy, coronary artery disease, and family history of sudden cardiac death presenting for a second evaluation of cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 178 ml/m2 (normal range: 74+/-15), the LVEDV is 328 ml (normal range 142+/-34), the LV end systolic volume index is 136 ml/m2 (normal range 25+/-9), the LVESV is 250 ml (normal range 47+/-19), the LV mass index is 82 g/m2 (normal range 85+/-15), and the LV mass is 151 g (normal range 164+/-36). There systolic dysfunction appears global with septal bounce consistent with LBBB. There is a small amount of late gadolinium enhancement which is located in the basal inferior wall and spares the endocardium. The pattern is atypical for prior myocardial infarction. It involves <5% of the LV mass and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding is consistent with either vasculitis or cardiac sarcoidosis, but the differential diagnosis also involves many other processes.Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets appear tethered with moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant 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 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. Severe LV dilation with severely reduced systolic function (LVEF 24%). There is a small amount of late gadolinium enhancement. The pattern is atypical for prior myocardial infarction. It involves <5% of the LV mass and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding is consistent with either vasculitis or cardiac sarcoidosis, but the differential diagnosis also involves many other processes.2. Normal RV size with moderately reduced systolic function (RVEF 33%).3. Severe left atrial dilation.4. Moderate mitral regurgitation. 