71Yrs male with a hx of CAD s/p CABG 5/2016, HFpEF, HTN, HLD, CKD, PAD and recent diagnosis of amyloid presenting from cardiology clinic with concern for cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with severe concentric hypertrophy and normal systolic function. The overall LV ejection fraction is 55%. The LVEDV is 157 ml (normal range 142+/-34), the LV end diastolic volume index is 79 ml/m2 (normal range: 74+/-15), the LVESV is 71 ml (normal range 47+/-19) and the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9). The LV mass is 165 g (normal range 164+/-36) and the LV mass index is 84 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation time is normal (1013-1053 ms). However, on TI imaging, the blood pool and myocardium null at the same time. This, along with subtle diffuse subendocardial late gadolinium enhancement, is highly consistent with a diagnosis of cardiac amyloid deposition.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. There is no left atrial appendage thrombus.Right VentricleThe right ventricle is normal ion size with mild to moderate hypertrophy and normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 138 ml (normal range 142+/-31), RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVESV is 65 ml (normal range 54+/-17), and the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate eccentric mitral regurgitation directed to worse the lateral left atrial wall. There is systolic anterior motion of the mitral valve causing flow turbulence in the left ventricular outflow tract.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 FindingsLarge right pleural effusion. Small left pleural effusion. Elevation of the left hemidiaphragm suggesting left phrenic nerve or hemidiaphragmatic dysfunction, as before. 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.TI imaging with nulling of the blood pool and myocardium together is highly diagnostic of cardiac amyloidosis. 2.Subtle diffuse subendocardial late gadolinium enhancement, highly consistent with a diagnosis of cardiac amyloidosis.3.Normal left ventricular size and systolic function (LVEF 55%) with severe concentric hypertrophy.4.Systolic anterior motion of the mitral valve with flow acceleration in the left ventricular outflow tract. 5.Moderate mitral regurgitation with an eccentric jet directed to the lateral left atrial wall. 6.Moderate left and right atrial dilation.7.Normal right ventricular size and systolic function (RVEF 53%) with mild to moderate hypertrophy.8.Large right and small left pleural effusion.9.Elevation of the left hemidiaphragm suggesting left phrenic nerve or hemidiaphragmatic dysfunction, as before.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.