72 year old male with a past medical history significant for COPD, CAD, HFpEF, severe LVH (with concern for infiltrative process), intracavitary gradient, HTN, DM2, and CKD presenting with worsening dyspnea. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function with severe concentric left ventricular hypertrophy (15-16mm). The overall LV ejection fraction is 69%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 231 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Native T1 times are 1110 ms, which is mildly elevated. Given the amount of hypertrophy, one would expect moderate to severe elevations in the native myocardial T1 relaxation time in the case of cardiac amyloidosis. I suspect the mild elevation in native myocardial T1 relaxation times is most likely due to mild, diffuse interstitial fibrosis rather than infiltrative heart disease.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 232 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 96 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in sizeAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 a moderate to large pericardial effusion which is mostly overlying the posterior left ventricle. There is no cine evidence of chamber collapse. Extracardiac FindingsThere is ascites seen. 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 hyperdynamic systolic function with severe concentric left ventricular hypertrophy (15-16mm). The overall LV ejection fraction is 69%. The native myocardial T1 relaxation time is mildly elevated. Given the fact that the severe LVH is only associated with a mild elevation in native myocardial T1 relaxation time, I suspect the elevated T1 is most likely due to mild, diffuse interstitial fibrosis rather than infiltrative heart disease.2. The right ventricle is normal in size and systolic function (RVEF 58%). 3. Moderate to large pericardial effusion without evidence of obvious hemodynamic compromise. The pericardial effusion is significantly larger than appreciated on his echocardiogram because most of it is posteriorly located.