45 year old man with a history of sarcoid, hypertension, and alcoholism. He presents with acute decompensated heart failure and is referred to evaluate for etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 8%, the LV end diastolic volume index is 193 ml/m2 (normal range: 74+/-15), the LVEDV is 332 ml (normal range 142+/-34), the LV end systolic volume index is 177 ml/m2 (normal range 25+/-9), the LVESV is 305 ml (normal range 47+/-19), the LV mass index is 139 g/m2 (normal range 85+/-15), and the LV mass is 239 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 14%, the RV end diastolic volume index is 135 ml/m2 (normal range 82+/-16), the RVEDV is 231 ml (normal range 142+/-31), the RV end systolic volume index is 115 ml/m2 (normal range 31+/-9), and the RVESV is 198 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated..Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate 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 a trace pericardial effusionExtracardiac FindingsThere is a small mediastinal lymph node noted. Large right pleural effusion. 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. Severe LV dilation with severely reduced systolic function (LVEF 8%). No evidence of underlying myocardial fibrosis, inflammation, or infiltration. This favors hypertension or alcohol as an etiology for the cardiomyopathy over sarcoidosis.2. Moderate RV dilation with severely reduced systolic function (RVEF 14%).3. Significant biatrial dilation.4. Moderate mitral regurgitation.