A 59 year old male with personal history of tonsil carcinoma, s/p chemotherapy, dysphagia and recurrent aspirations, hypothyroidism, with progressive dyspnea and newly diagnosed heart failure with severely reduced systolic function and positive troponin. Referred to cardiac MRI for further evaluation MEDICATIONS: aspirin, atorvastatin, furosemide, levothyroxine, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is mid-myocardial stripe of late gadolinium enhancement noted in the septum. This finding is atypical for prior myocardial infarction but suggests the presence of replacement fibrosis and is commonly described in non-ischemic cardiomyopathy. There is additionally a very small amount of non-transmural subendocardial late gadolinium enhancement involving the mid inferolateral wall, this finding could represent a small myocardial infarction. The segment with this small myocardial infarction has an intermediate probability of viability. The native myocardial T1 times are moderately increased (1100-1150ms), which suggest the presence of interstitial fibrosis. No evidence of cardiac amyloidosis or myocardial iron overload. Left VentricleThe left ventricle is severely dilated with moderately to severely reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 290 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 200 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 150 g. There is severe global hypokinesis with regional variation and desynchrony.Left AtriumThe left atrium is severely dilated (161ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 100 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 opens widely, there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsModerate bilateral pleural effusions and bilateral intersitial lung infiltrates. 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.
Cardiac MRI study is most consistent with diagnosis of non-ischemic cardiomyopathy with a very small concomitant myocardial infarction. 1. No perfusion defects/ "ischemia" present during hyperemia. 2. There is mid-myocardial stripe of late gadolinium enhancement noted in the septum. This finding is atypical for prior myocardial infarction but suggests the presence of fibrosis, inflammation, or infiltration and is commonly described in non-ischemic cardiomyopathy. There is additionally a very small amount of non-transmural subendocardial late gadolinium enhancement involving the mid inferolateral wall, this finding could represent a small myocardial infarction. The segment with this small myocardial infarction has an intermediate probability of viability. 3. The left ventricle is severely dilated with moderate to severely reduced systolic function (LVEF 31%). 4. The right ventricle is normal in size with normal systolic function (RVEF 54%).5. Severe biatrial dilation. 6. There is mild mitral and tricuspid regurgitation.7. There is a small pericardial effusion.8. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.