34 year old man with cardiomyopathy referred to evaluate etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 7%, the LV end diastolic volume index is 224 ml/m2 (normal range: 74+/-15), the LVEDV is 425 ml (normal range 142+/-34), the LV end systolic volume index is 208 ml/m2 (normal range 25+/-9), the LVESV is 395 ml (normal range 47+/-19), the LV mass index is 137 g/m2 (normal range 85+/-15), and the LV mass is 260 g (normal range 164+/-36). There is global hypokinesis. There is septal mid-wall late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is consistent with the patient's history of old myocarditis but is also well described in "classical" dilated cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 24%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 201 ml (normal range 142+/-31), the RV end systolic volume index is 80 ml/m2 (normal range 31+/-9), and the RVESV is 152 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 mild 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 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 7%). There is mid-wall late gadolinium enhancement of the interventricular septum. This finding most likely represents fibrosis related to either old myocarditis or "classical" dilated cardiomyopathy.2. Normal RV size with severely reduced systolic function (RVEF 24%). 3. Severe left atrial dilation. 